Your insurance policy is a contract between you and the insurance company.  Our reimbursement for services provided is also a based on a contract between Fairhaven Pediatrics and your insurance company.  As you are contractually obligated to pay your insurance premium, we are contractually obligated to charge for the services provided.

Understand your insurance benefits.  Depending on your insurance plan, some benefits are covered in full, some apply to your deductible if you have one, and other benefits are not covered.  Our clinic does not make these decisions so be sure to reach out to your health insurance if you have questions on what is covered and what is considered out of pocket, or the patient’s responsibility.

Carry your insurance card with you to your appointment.  We will need to verify insurance benefits before your child can be seen.  Your insurance card will have the names of all covered dependents, the policy and group numbers, the claims mailing address and phone number, and the copayment information.

Charges for services will vary.  Well checks are based on age, but other visits will vary based on many factors including time spent, medical complexity, number of diagnosis, and medical decision making.  Insurance companies may also limit what is covered under preventative care.  As we follow the American Academy of Pediatrics guidelines for preventive care, we perform developmental screenings including hearing and vision screening, hemoglobin and lead screening, and developmental questionnaires that your insurance may not cover.  It is important to check with your insurance plan to see what is covered and what charges will be your responsibility.

Patient Costs are usually co-pay, deductible, and coinsurance, depending on your insurance plan. Copay is the amount you are required to pay upfront before seeing a doctor.  It is part of the contract between you and your insurance company and is listed on your insurance card.  Deductible is the amount of money you must pay out of pocket before your insurance company will begin paying for claims filed by your doctor’s office.  Coinsurance is the amount you are still responsible for after meeting your deductible.  Deductibles and coinsurance reset annually.