Frequently Asked Questions
In this ever-changing world of health insurance, it is imperative that you know and understand your health plan. You may ask yourself “how can I possibly handle that?” It’s actually quite simple if you start with the basics. Below you will find a brief guide to give you an introduction to health insurance.
Do you take my insurance?
A Bright Future Pediatrics accepts most major insurance plans, including, but not limited to:
- Accountable PPO
- Aetna HMO/PPO Option II
- Averde Non-Gated PPO
- BCBS PPO/HMO
- Beech Street PPO
- Cigna PPO/OAP/HMO
- Coalition America (Formerly NPPN)
- First Health/Coventry PPO-Dir Payors
- First Health/Coventry PPO-Ntwk Lease Payors
- Galaxy PPO
- GREAT WEST
- HealthSmart GEPO/ACCEL(NORTH TEXAS HEALTCARE)
- HealthSmart PPO/POS
- Humana Choice Care PPO
- IMS PPO
- Independent Medical Systems – PPO
- MultiPlan PPO
- PlanVista PPO (NPPN)
- Principal Edge Network PPO
- Principal Edge PPO
- Texas True Choice PPO
- United Non-Options
- United Options PPO
- USA MCO
- Viant/Beech Street/ppoNext
Prompt-pay discount is provided to self-pay patients when payment is made in full at the time of visit for our services.
The best way to know for sure whether we accept your insurance plan is to check your insurance company’s provider listing. Call us if your insurance plan is not listed.
What if my child is ill and your office is closed for the evening or weekend?
One of our board-certified pediatricians will be available 24/7 for after-hours calls!
Please call us at 972-208-8668 if you are worried about your child so that we can assist in determining if they need to be seen immediately in an outside urgent care or emergency department or if they would benefit from watchful waiting overnight.
If you need to speak with our physician on-call for urgent matters only, please call A Bright Future Pediatrics at 972-208-8668. All after-hour calls will be answered within a timely manner. There will be a $25.00 charge for all physician phone calls after regular business hours.
If you have an emergency medical need, please call 911 or go to the nearest emergency room. We have a physician on-call 7 days a week for emergencies only.
If you have routine questions, please call during our office hours. If you need to speak with our on-call physician for urgent matters only, please call A Bright Future Pediatrics at (972) 208-8668. All after-hour calls will be answered within a timely manner.
If you have a question regarding medication dosage, please call your local 24-hour pharmacy or your insurance nurse line.
If you need routine medical advice outside of regular office hours, please call your insurance nurse line
Will the doctors call in a prescription for my child?
I have to work and cannot come to my child’s appointment. Can I send another adult in my place?
If the accompanying adult does not know the child’s medical history or current medications, there is a significant language barrier, or at the doctor’s discretion, we reserve the right to reschedule an appointment for a time when a parent can be present.
How can I get a copy of my child’s immunization record?
How much of an over-the-counter medication should I give my child?
If I have questions about my policy where can I get them answered?
Where do I obtain information about my health plan?
How do I know if my policy changed?
Isn’t my doctor’s office responsible for knowing my benefits?
Why does my doctor’s staff need to know my social security number?
What are “prior authorizations”?
What does “participating provider” or “preferred provider” mean?
How can I find out if something is a covered service?
Additionally, review the explanation of benefits that your insurance carrier sends you after you have received medical services. This will explain your charges and how it was reviewed and paid according to your policy by the insurance carrier. Any dollar amounts you owe will match the statement you receive from the medical provider, as the medical provider obtains their information from the insurance carrier.
What are deductibles, co-payments, and co-insurance?
Deductibles: This is a set dollar amount that is required annually to be paid by the insured. The insurance will not pay any of your claims until this amount is paid by the patient. The medical provider must collect in full and is not allowed to adjust off any portion of this payment. You can call the number on your insurance card and they will be able to advise you of your deductible. They can also tell you if you have satisfied your deductible for the calendar year.
Co-payments: A set dollar amount that you are required to pay according to your insurance policy at each office visit.
Co-insurance: The portion of medical expenses that you are responsible for after the deductible is met and the insurance has paid its portion. For example, your policy may read 80/20, meaning that your insurance will pay 80% of the claim and you will be responsible for the remaining 20%.
Your policy manual can provide you with this information. Your insurance company determines the amount you pay. Again, medical providers are not allowed to adjust off your co-payments or deductibles. It is your obligation to pay these amounts.
When is payment expected?
Why was I billed for my newborn’s charges?
Why didn’t my physician advise me that the vision screen, hearing screen (OAE), or Visual Evoked Potential (VEP) test would not be covered under my insurance plan?
Why does it take so long to receive a statement from A Bright Future Pediatrics?
Claims sent electronically will usually be paid within a 90-day time period. Claims sent via paper will usually take over 90 days before they will be paid.
If insurance request medical records or any additional information regarding the date of service, this can take additional time for the claim to be completed. If there is a portion left over that is the responsibility of the patient, a statement is generated. This could be 6 months to 9 months before all of the above activity is completed.