We are providing this information to help you understand the difference between what is covered within a well visit vs. a problem-oriented visit. Catawba Pediatrics recommends regular well visits, also known as preventive exams, physicals, or well child checkups, per the American Academy of Pediatrics guidelines. Due to recent changes in the health insurance industry, our billing department receives many calls from parents with questions regarding their bills and charges incurred during these visits.
Know your benefits! It is your responsibility to know your coverage details, below is some helpful information to help you understand your coverage. With higher deductible and health saving accounts, check your insurance plan for limited benefits.
Screening: During well visits, we perform recommended screenings appropriate to age and seek to uncover any conditions that may lead to suboptimal health in the years to come. In our experience, some insurance plans cover these screenings and some do not. Because there are so many different insurance companies and plans, we do not know in advance what will and will not be covered. It is your responsibility to understand what screening services are covered by your insurance plan. The following are screenings that may be performed: Developmental Questionnaire, MCHAT(Modified Checklist for Autism in Toddlers, Hearing & Vision Screening, PHQ-2 (Patient Health Questionnaire), Behavioral Assessment, and Fluoride Treatment.
Please note at the well exam if we address any problem-oriented concerns (such as ear infections, ADHD concerns, wart treatments, ear lavage, etc.) at the visit, this requires us to bill your insurance for both the well exam and additional evaluation of problems discussed. In doing so you could incur additional fees. By addressing other issues at well checks this is an added convenience so you do not have to return for a separate office visit.
Deductible: Your deductible is a specified amount of money that you may be required to pay before insurance will pay for certain services.
Coinsurance: Is a type of insurance in which the insured pays a share of the payment made against a claim.
Copay: A fixed amount you pay for a covered health care service, and after you have met your deductible.
Non-Covered Services: These will vary depending on your insurance plan and you will be responsible for the fees incurred with service.
After Hours/Weekend Charges: Please note that we do charge a fee for our services on weekends and holidays. These fees may be a non-covered service by your insurance company.
We file claims with all in network insurances as a courtesy. If you have any questions if whether we are in network with your insurance plan or if you need further explanation about incurring additional fees for services provided during your visit, please speak with your insurance company.
Medicaid Managed Care:
- Medicaid Direct
- United Health Care
- Wellcare
- Carolina Complete Health
- Blue Cross Blue Shield Healthy Blue
- AmeriHealth Caritas
Catawba Pediatrics participates with the following carriers:
- Blue Cross Blue Sheild
- United Health Care
- Medcost
- Cigna
- The Health Plan
- Tricare Military Humana
- ChampVA
- Healthgram
- Healthsmart
- Aetna
- UMR
AS WELL AS MANY OTHER PLANS- since there are so many insurance options available, please check with your insurance by using tax ID# 561168510
We are considered out of network with the following carriers:
- PHCS
We do not participate with the following carriers:
- Humana
- National Foundation Life
- Medishare
- Liberty Share
- Christian Ministry
- Ambetter
- Commercial Wellcare
- Commercial Amerihealth
- Bright Healthcare
- Friday Health Plan
Please bring your insurance card with you to every visit. If we file your claim, you are responsible for the copay at the time of visit. If we are not a provider for your insurance, if you are not insured or we do not file with your insurance, you will be responsible for the entire charge at the time of service.
Payment Options
We accept checks, cash or credit cards. We also offer a flexible payment plan. Please see our Financial Coordinator for details.
