Q. If I chose one of your physicians as my primary care doctor and I am unable to get my child in to that physician on a given day, can I see another physician, physician assistant, or nurse practitioner in your group without a referral?
A. Yes, you are able to see any physician within our group and no referral is needed. Our physicians all participate with the same insurance plans and are able to cover for each other in the event you are not able to be seen by your primary care physician.
Q. Why must I show my insurance card at each visit?
A. It is the policy of this office to verify your insurance monthly. Often, insurance plans can make small changes, such as your group number or your co-payment, even though you stay with the same carrier. Your employer may also change plans. In order to most accurately bill insurance on your behalf, we strive to verify this information monthly.
Below are just a few of the most common asked billing questions. If you have any additional questions, please call the Seven Hills Pediatrics billing department at 469-543-0630.
Q. What to do if you think there is an error with your account or have questions about your bill?
A. Please contact us as soon as possible at 469-543-0630. We must hear from you no later than 60 days after your first bill is sent on which the error problem appeared.
You can telephone us, but doing so will not preserve your rights. In writing, give us the following information: your name, account number, the dollar amount of the suspected error, the posting date of the transaction in question, and an explanation of why you believe there is an error. If you need more information, describe the item you are unsure about. Please be sure the person responsible for the account signs all correspondence.
Q. Does your office participate with my insurance plan?
A.Our office participates with many of the major plans in the Midwest.
It is always wise to verify current participation for any physician with your plan customer service. You can also call one of our billing staff and we will be happy to assist you.
Q. Do you submit insurance claims for us?
A. Our billing department will make two attempts to obtain payment from your insurance carrier. We submit your claim once you have been seen and then again in 30 days if no payment is made by your insurance carrier. At 60 days if no payment is received by your insurance, we will then bill you and ask that you assist us in following up with your insurance plan.
Q. Will my insurance pay for:
A. The billing department often gets questions regarding which charges will or will not be covered by your insurance. There are many different types of insurance policies and they all process claims differently. It is your responsibility to verify with your insurance if they will cover a particular service. If your insurance requires the procedure code and/or price, please contact us.
Q. What is a Co-Pay?
A. A co-pay is a specific amount that you are required to pay at the time of each visit. Seven Hills Pediatrics does require the co-pay to be paid at the time of each visit. Depending on your plan, you may have to pay both coinsurance and a co-pay for a given doctor's visit. Some carriers do not assess copays for well child visits. If you are sure that yours does not, please inform the front desk at the time of check in.
Q. What is Co-Insurance?
A. This usually means the insurance company pays a certain percentage of our health care bills, while you pay the remaining percentage. In some cases, you may not be expected to pay any coinsurance.
Q. What is a Deductible?
A. Deductible refers to the amount of money you have to pay before your insurance company pays for any health benefits. Once you meet this amount, your insurance benefits go into effect.
Q. Will my newborn be automatically covered under my insurance?
A. Many times newborns are not automatically added to a policy. Insurance companies require that you contact them for enrollment.
Q. What does COB (coordination of benefits) mean?
A. Today, many families are covered by more than one health insurance plan. When two or more health insurance plans cover the insured and dependents, one plan becomes the primary plan and the other plan is the secondary plan. Once a year, most insurance companies will request COB information from the insured to verify whether or not there is any other health insurance. Many times, an insurance company will not process any additional claims until the requested information is received.
Q. How will I be billed for services?
A. Our office sends out statements monthly on any balance that is due from you after your insurance has settled the claim for your child’s services. You are billed for any deductibles, coinsurance or other out of pocket expenses determined by your insurance carrier.
Q. How do I make a payment?
A. Our office accepts payments by cash, check or credit card.
Q. How do I obtain a copy of my child's medical record or immunization record?
A. Medical Records Release requests for a medical record and/or an immunization record must be made in writing and submitted to any of our office locations or faxed to (469) 543-0630
If you would like to request that another office send records to Seven Hills please fill out the following form.
If you would like to request that Seven Hills Pediatrics send copies of records please fill out the following form.