Insurance Policies and Pediatrics by the Sea
Pediatrics by the Sea is affiliated with most managed health care programs. If you are a member of one of these groups, you must present both your health insurance card and photo id at the time of your visit. Because your program may have provisions regarding where lab and consults are referred, we need to know your plan type. Please familiarize yourself with your plan and your responsibilities as the subscriber and understand that you are responsible for the balance on your account if your managed health care program rejects a claim.
Copayments: All members of health insurances that have a co-payment policy will be expected to pay this co-payment at the time of each visit. This includes whether you are seen for a well, sick, or follow up visit. The amount of the co-payment varies depending on your insurance plan.
HMO's: Participants with many managed health care programs (HMO's) must always use their primary care physician (PCP) to coordinate all of the patient's care, i.e. referrals to specialists, emergency room visits, out patient procedures, and laboratory work. We as PCP's can refer only to other specialists who are participants in your health plan.
PPO's: Other health insurance plans (PPO's) may not require us to be used as your primary "gatekeeper", but we still are required to call ahead for pre-certification for hospitalization or other procedures. You will also have more flexibility in physician choice.
Newborn Policy: All families with newborns are given a 30 day grace period in which they can put their newborns on their insurance plan or set up the newborns' Medicaid. During this 30 day grace period, we will accept pending insurance coverage. After the grace period has expired, however, the parents are required to show insurance coverage for the infant effective for the previous visits, or the parents will owe for all previous visits.