We participate with most insurance carriers who do business in the Lexington market.  Please remember that your insurance company is YOUR insurance company, not ours.  Some companies are more user-friendly than others, and some may require precertification for visits, tests, and procedures.  We normally handle most of these tasks as a service to you, though it is not our responsibility to do this.  If getting precertification for any visit, test, or procedure is burdensome, we may ask you to work directly with your primary care provider or your insurance company for approval.

Please refer to the Patient Information section of this website to learn what insurance information we will need prior to your visit.  If we do not participate with your insurance company, this does not mean we do not want to see your child.  We simply may not be aware of your insurance company, or we may not have a participation agreement with it.  Feel free to schedule an appointment.  Depending on your plan, you may be expected to pay your entire bill at the time of service.  We would then provide you with the proper codes and format which you can then submit to your insurance company for reimbursement.  

It is your responsibility to make sure services we provide for you child are reimbursed by your insurance company in a timely fashion.  You should be aware of any copays, co-insurance and/or deductibles for which you are responsible before your visit.  Please don’t ask us to bill your copay.  Copays are contractually expected at the time of service, and we will ask you to reschedule if you show up without your copay.

In this era of modern medicine, any interaction between a physician and a patient generates treatment codes for reimbursement purposes.  As a service to you, we submit these codes to your insurance company electronically on your behalf.  If, after your insurance company has processed the treatment codes we have submitted on your behalf, you may owe a balance.  You should receive a bill from us for the balance, and this bill should match the amount your insurance company has already informed you that you owe to us.  We expect payment in full within 30 days of receipt of your bill.  If this will not be possible, please contact our office.  Unpaid balances will be promptly sent to a collection agency or an attorney for further action.

Occasionally, families ask whether or not they will be charged for a follow-up evaluation after an operation.  For most procedures there is a period of time (the “global period”) after the procedure during which we are not permitted to charge you for the office visit by virtue of our contract with your insurance company, unless certain circumstances occur.  This does not apply to office procedures, ultrasounds, or lab tests.  Conversely, we are contractually obligated to charge you for evaluations after the global period.  Global periods exist so that you are not charged for things like taking out stitches.  Global periods are brief because they are not intended to provide for ongoing free care.  Our policy is to schedule post-operative visits when we feel it is time to reassess your child.  Because we cannot keep track of the different and ever-changing policies of various insurance companies, we typically charge a nominal fee for immediate post-operative assessments.  This includes your copay, if you have one.  If your visit has occurred during the global period, your insurance company will inform you and us.  If you have made a copay for a visit that occurred within the global period, your copay will be refunded, unless you have an outstanding balance.  Please contact the office if you believe you are owed a refund.  If you expect additional visits to our office, any credit to you may be applied to future liabilities.