Health Insurance

Insurance benefits can be very complicated. It is important to understand your health insurance coverage so that you can be an active advocate for your child. The rights you have depend on how you get your insurance, the type of plan you have, and the state in which you live.

The following articles are intended to help you understand the pediatric-related benefits of your insurance plan and should not be used as a substitute for the information found in your health insurance contract.   https://www.healthychildren.org/English/family-life/health-management/health-insurance/Pages/default.aspx

OFFICE POLICIES, INSURANCE COMPANIES WE ACCEPT, CO-PAYMENTS, NEWBORNS, FAQ 

We accept most PPO, including covered California PPO (does not include EPOS, EOS, HMO)

• Anthem Blue Cross
• Aetna 
• Blue Shield
• CIGNA
• EBA&M
• Healthnet
• Motion Picture
• Oscar
• United Healthcare
• Tricare
• UMR
• Web TPA 

• We do not accept any Medi-Cal.
• We do not accept any HMO plans, unless they are offered through Regal or Lakeside Medical groups.
• Please remember to name Dr. Weidman as your primary care physician

We will bill your health insurance company for your child’s services. You will receive a statement for any portion that is your responsibility.  If your child is not covered by insurance, you will need to pay the bill or make payment arrangements. You can pay by cash or check, or with Visa, Discover, American Express or MasterCard credit cards

In order to file promptly and accurately, your insurance company requires you to provide us with a valid and current insurance card at each visit. 

Today, there are 1000's of health insurance plans, with different types of benefits, co-pays, co-insurances and deductibles. Each patient is responsible for knowing his or her plan’s benefits package, co-payment, co-insurance, deductible, non-covered services, and restrictions.

We will not bill another insurance carrier supplied at a later date, if it is past the timely filing period for that insurance company. If a child is insured by more than one insurance company, our office needs to have all insurance companies’ names on file.

YOUR RESPONSIBILITY

Our billing department will only bill the insurance with the information you provide us.  If the insurance company asks for you to call them to coordinate the benefits,  then you will be responsible for doing so on a timely basis. Ultimately, we hold both parents responsible for payment. In circumstances where the parents are separated or divorced, we will not act as a mediator in collecting our payments. If the account is not resolved in a timely manner, both parent’s information will be submitted to our collection agency. 

CO-PAYMENT, CO-INSURANCE AND DEDUCTIBLES

All co-payments, co-insurance and deductibles are due and payable at the time of service per your insurance company.

We are contractually obligated to collect your co-payment at the time of each visit. The cost of billing co-payments often exceeds the actual co-payment amount, therefore, our policy will be to charge a processing fee if you do not pay your co-payment at the time of service.

NO INSURANCE

Full payment will be due at the time of service.

NEWBORNS

You only have 30 days to add your newborn from their date of birth. Because it takes the insurance plans a long time to add newborns, you must add your newborn baby within the first few days of birth by calling your insurance agent, your insurance company, or your employer’s human resource department. Ask them what you need to do to add your baby (and complete your newborn baby’s enrollment process) to your insurance plan. Every insurance plan is different, but it usually takes them 2-3 weeks to add the baby. If you don’t add the baby within 30 days from birth – your insurance will not add the newborn at a later date, and you will have to pay for all newborn care which is very expensive for you.  We apologize, but this is something that only must do, and can do – even though the insurance company knows that the mother is pregnant- they will not add a newborn until you ask them to.

RETURNED CHECKS

A $50.00 charge will be added to your account for any check returned by your bank for any reason.

STATEMENTS

Billing statements are mailed monthly. All patient balances are due in full upon receipt.  Accounts with unpaid balances over 30 days may be sent to our collection agency.

FREQUENTLY ASKED QUESTIONS

Q: What if I forget my insurance card? 

If insurance coverage cannot be verified, you will be expected to pay in full at the time of service. If you are unable to pay the charges in full, you may be asked to re-schedule your appointment or make payment arrangements with our billing department prior to your visit.

Q: What happens if I can’t pay my co-payment? 

If you forget your checkbook, credit card or cash, you may call the office prior to the close of day with your credit card number and you will not be assessed the processing fee.

Q: My divorce decree states my ex-spouse is responsible for all charges incurred - what if my ex doesn’t pay? 

They you will be liable. We ultimately hold both parents responsible and will try to resolve the balance in a timely manner. If we are unable to resolve the account, it will be sent to collection with both parent’s information.

REFILLS

To refill prescriptions, you can call the office during regular office hours. Please have the name of the pharmacy, address and phone number. Federal law does not allow after hours phone refills of controlled substances.

APPOINTMENTS

We see both well and sick newborns, babies, tots, children, adolescents, teenagers and college students every day. We encourage you to schedule well visits as soon as possible, especially summer check-ups. This enables you to have your preference of provider, day and time of appointment.

Same day sick visits are available.  We ask that you call as early as possible that day, to ensure that we will have adequate time to see everyone.

LATE ARRIVALS

Patients arriving late for an appointment may be asked to reschedule. We will try to accommodate late-comers as best as possible, but cannot compromise on the quality and timely care provided to our other patients. You may be given the option to wait for another appointment time on the same day if one is available. If we cannot accommodate you into the schedule, we will ask that you reschedule for another day and time that is convenient for you and your child.

MISSED APPOINTMENTS

We understand occasional circumstances prevent you from keeping your scheduled appointment. Please notify our office in advance if you’re running late, or unable to make your appointment, and we will do our best to reschedule you. There will be a missed appointment fee of $80 (sick) to $100 (well child) per child for .appointments cancelled less than 24 hours before the appointment time.

AFTER HOURS CARE

We understand that sickness can occur at any time. If your child is experiencing a life-threatening emergency, CALL 911 for immediate help.

For after hours emergency calls, you can speak with someone from our answering service, who will page the on-call provider. The provider will then return your call at the number you provide. If you don’t hear from the provider on call within 30 minutes, please call our number again, and the provider will be re-paged.

Federal law does not allow after hours phone refills of controlled substances.

For non-emergency calls or questions (appointments, school or camp issues, or billing questions) please call our office during regular office hours.

SCHOOL FORMS, DAY CARE AND SPORTS FORMS, CAMP FORMS. 

Most schools, day cares , camp and sports organizations require a pre-participation physical form or a child medical statement form to be completed prior to allowing your child to enroll or participate. Due to the volume of requests we receive, we ask that you give us at least 3 business days to complete your child’s forms. After that, you may pick them up at your convenience. When possible, we will email and or post to the patient portal. Please note: In order for us to properly complete any forms, your child needs to have had a check-up within the past year or less (depending upon the school, the sport or the camp.

DIVORCED AND /OR SEPARATED PARENTS

Children of divorced or separated parents sometimes present our practice with unique challenges; therefore the following policy has been established to avoid misunderstandings going forward.

The medical doctors and office staff will not be put in the middle of domestic issues or disagreements over the phone or in the office.

1. Please make decisions regarding appointments, vaccinating and/or any office procedures PRIOR to visiting our practice.

2. “Joint Custody” means that each parent has equal access to the child’s medical records. Without a court order, we will not stop either parent from looking at their child’s chart or obtaining test results. If there is a dispute between the parents regarding custody, and a custody agreement has been reached, we will need to see documentation specifying the legal guardian.

3. Only in situations where there is a confirmed, documented Court Order, will one of the parent’s be denied access to the minor child’s health records or visits at the office. A copy of this Court Order must be provided to us, and placed in the minor child’s electronic chart at our office.

4. If there is NOT a Court Order on file with our office, we will assume that either parent or their named individual (in writing) that accompanies your minor child is authorized (including any named individuals like grandparents, nannies etc.) to bring your child to our practice, to be present during the visit and to consent to any treatment during that visit. We will not be involved in any disputes regarding named individuals on the consent forms unless instructed by a Court Order. Either parent can schedule an appointment for their child, be present for the visit and/or obtain a copy of the visit summary. (Subject to medical records fee.)

5. It is both parents’ responsibility to communicate with each other about their chid’s care, office visit dates and any other pertinent information relevant to their child.  It is not the responsibility of the physician to communicate visit information to “each” custodial parent separately. Our physicians will not call the non-attending parent following visits. Additionally, we will not call a parent to notify of an appointment scheduled by the other.

6. The responsibility of the bill for minors is with both parents. It is our policy to collect past due and current co-pays and/or deductible payment at the time of service from the parent, named individual or caretaker who brings the child in for the appointment.

7. The parent who completes the information sheet and signs the assignment and release will be the Guarantor, regardless of insurance coverage, and will be legally responsible to pay the bills.

8. We reserve the right to charge an administrative fee for copying records should the requests become excessive.

9. Should the issues that come between parents become disruptive to our organization or there is non-compliance with this policy, we reserve the right to discharge the family from the practice.

10. Remember - we are your kid's doc - and do not get involved with parental disputes. 

NOTICE OF PRIVACY PRACTICES 

Our Privacy Practices are contained in the attached PDF: notice-of-privacy-practices.pdf

INFORMATION SHARING POLICY

Our Information Sharing Policy is contained in the attached PDF:  information-sharing-policy.pdf