Over the past fifteen years medical insurance has become more and more complex. Managed care, with all its variations, has introduced us to a different health care world with a whole new vocabulary: HMO, PPO, POS, co-pay, pre-certification, in-network, out-of network, and so on. This can be confusing and challenging for our families and physicians.

Hales Pediatrics’ physicians are approved providers under dozens of insurance plans. Please check with us if you do not find us listed in your provider directory. We sometimes find that our physicians’ names have been omitted from lists of approved providers even when we are active providers for the plan.

Insurance procedures or coverage will sometimes change between visits. For this reason, and to help us ensure that insurance requirements are properly handled, we ask that you bring with you to each visit the following:

  • Current health insurance card for the patient
  • Co-payment, as required by your plan
  • Calendar, so you may schedule your child/children’s next visit before you leave

We will do all we can to help this go smoothly. As part of our service to you, and as a courtesy, we will file and document charges with your insurer. Ultimately, however, the financial responsibility for charges incurred for services provided in our office is yours.

As you plan for the arrival of your baby and/or the transfer of your child/children’s medical care, you should be sure that insurance details are arranged well in advance. Now is a good time to request enrollment forms for insurance conversion to include dependent coverage. Once your baby is born, it is your responsibility to inform your insurance company. You may list any one of our physicians as your child/children’s PCP or “Primary Care Physician”.

If you have questions about billing or your insurance claims please contact our billing and insurance staff, headed by Cheri.