Insurance Policies

North Atlanta Pediatric Associates is enrolled in numerous managed care insurance programs. We are pleased to provide this service to our patients; however it is impossible for us to keep track of each plan’s individual requirements. Please make sure you understand the benefits and requirements of your insurance plan and be aware of any changes that may occur over time. Plans differ depending on the type of contract that you or your employer may have negotiated. Most plans have stipulations regarding how often, where, and by whom medical services may be rendered. For example, some plans do not cover the hearing and vision testing we provide beginning at four (4) years of age. Some plans have wellness maximums based on a dollar amount or on a set number of visits within a certain time frame. A majority of plans require wellness visits to be at least one full calendar year from the last wellness exam in order to be covered; and some wellness visits may not be covered over a certain age. Your insurance is a contract between you and your insurance company; therefore, it is very important that you take an active role in understanding your benefits.
PLEASE NOTE: North Atlanta Pediatric Associates does not file secondary insurance claims.

Newborns

It is important that you add your newborn to your insurance policy within their first 30 days of life. This will prevent any lapse in coverage. Contact your human resources department or insurance provider to obtain the proper paperwork and their policy-specific guidelines.

Primary Care Physician

If you have a plan that requires a primary care physician (usually an HMO or POS), you must specify your selection to the insurance company. The majority of companies will not back-date a primary care physician selection, so it is important that your choice is specified before you are seen by one of our providers in order for the claim to process correctly. Some of the newer plans have an option where a primary care physician is not required; however, specialist copayments may apply.
Please visit our Frequently Asked Questions section below if you have questions that were not answered in the above information. If you have specific questions regarding a bill you received from our office, please contact our business office at 404-917-0964.

Frequently Asked Questions

What is COB?

COB stands for Coordination of Benefits. Most insurance companies send out a yearly questionnaire inquiring whether you have other insurance coverage. Claims are typically pended once this information has been requested from the member and will not be paid until the policy is updated. It is the policyholder’s responsibility to update this information in order to ensure proper claims processing. The policyholder will be held responsible for any and all charges incurred until they update this information with the insurance company.
My child has double coverage. How do I know which one is primary?

When there is double coverage, the “birthday rule” applies. The parent whose birthday falls earlier in the year is named as the primary insurance and the other is secondary. North Atlanta Pediatric Associates does not file secondary insurance claims.
I have received a bill from your office. Did you file my insurance?

If we participate with your insurance company, we will file your insurance for each visit. Claims are submitted daily. You will not receive a statement unless we have received correspondence from your insurance company stating that a balance is due from you.
My bill states a deductible and/or coinsurance applied. What does that mean?

A deductible is the amount of out-of-pocket expenses that you must pay the doctor or hospital before your policy will pay any benefits. Co-insurance is the percentage that the insurance company will pay from the total claim. It is the ratio of splitting the bill between the insurance company and you. Because each plan differs, you will need to check with your insurance company or your schedule of benefits to find out what services apply to your deductible or co-insurance.
What is a High Deductible Health Plan (HDHP)?

This is a plan that features higher deductibles than traditional insurance plans. These plans can usually be combined with a health savings account or a health reimbursement arrangement to allow you to pay for qualified out-of-pocket medical expenses on a pre-tax basis.

List of Insurance Carriers

North Atlanta Pediatric Associates has contracts with the following insurance carriers:

Aetna
Anthem BCBS
Cigna
Humana
United Healthcare
PHCS
Multiplan

Please be aware that the above list of insurance providers is subject to change at any time. North Atlanta Pediatric Associates’ participation with your insurance carrier does not guarantee payment of services. You are ultimately responsible for any and all charges.

Marketplace Products & Plans

Anthem/BCBS
Aetna
Cigna + Oscar
Humana
United Healthcare

We always recommend that you contact your insurance company to verify if your provider is in network with your plan before making any appointments.

Financial Policy

The following is a statement of our Financial Policy which we require you to read and sign prior to treatment:
Due to frequent changes in health insurance coverage, we require that you provide proof of insurance coverage at each visit. If you do not have insurance, are unable to provide proof of insurance coverage, or are on an insurance plan in which we do not participate, full payment will be required at the time of your visit.

All co-payments are due at the time of service. These fees cannot be waived. All co-pays not collected at the time of service will incur a $10 billing fee. Please be aware that some services provided may be non-covered services and not reimbursable by your insurance. You are personally responsible for these services. For your convenience, we accept cash, check, Visa/Master Card (including debit cards), American Express, and Discover.

If we are a participating provider, we will file your insurance for each visit. Should there be a dispute with your insurance company, our insurance department will attempt to resolve it for you. During this time, the balance may be transferred to your responsibility. Please note that your insurance policy is a contract between you and your insurance company; therefore, your balance is your responsibility.

Missed appointments for routine/preventive care are very disruptive to our office and deprive others of an appointment to see the doctor. Twenty-four (24) hour cancellation for routine check-ups is required to avoid the $80 charge.

Financial arrangements for large balances can be made through our payment program. Failure to resolve any past due accounts, including returned checks, may result in referral to a collection agency. Any family whose account is forwarded to a collection agency may be dismissed from our practice.

Requests for transfer of medical records will incur an administrative fee of $20 per child up to two and $35 for 3 or more children. An immunization record can be provided at no charge for active patients.

Effective January 1, 2024, our annual administrative fee will be $20 per patient. This fee ensures that our patients have access to our own 24 hour nurse advice line, care coordination/referrals, and completion of standard school, camp and sports physical forms within 72 business hours. RUSH forms including ADHD medication refills will still incur an additional $20 fee. In lieu of the annual fee, parents may choose to pay $10 per form as needed.

Insurance