billing-information twincity pediatrics

Billing Information

Twin City Pediatrics Insurance and Billing Overview

All insurance co-payments and deductibles for children's health care are due at the time of service and will be collected at check-in. If we do not have a contracted arrangement with your insurance plan, you will be expected to pay in full at the time of service. We accept cash, checks, MasterCard and Visa as payment options.

We will gladly file your medical charges with your insurance carrier. If payment has not been received within 45 days of filing, you will be notified and asked to contact your insurance company.

We accept assignment for most major insurance plans. Please contact your insurance carrier to confirm that our practice is a provider.

Please note that After Hours appointments are subject to an additional charge which is covered by some insurance plans but not others.

Payer Plan Type
BCBS  - All Products HMO;POS;PPO; Individual
CIGNA HealthCare of NC, Inc. HMO; PPO; POS
First Health (CCN) PPO; Workers Comp
Humana (ChoiceCare) PPO
MedCost  PPO, POS
Medicaid HMO
MAMSI Life & Health and Alliance (PPO) HMO;PPO
MultiPlan PPO
Great West Healthcare (formerly One Health Plan) HMO;POS;PPO
Partners Medicare Choice Medicare HMO
Primary Physician Care PPO
Private Healthcare Systems -  Repricer (PHCS) PPO, POS
Provider Select Inc. PPO
SouthCare PPO (formerly ETHIX) PPO
TriCare Standard and Prime Indemnity
United Health Care PPO;POS;EPO;HMO
Wellpath Coventry PPO

Twin City Pediatrics recognizes that health care costs can be significant and insurance premiums have risen rapidly in the last several years.  While the healthcare and insurance world has changed around us, we have always had a goal of providing personalized, evidence based, compassionate care to all our patients. 

We strive to keep your children healthy and follow the recommendations of the American Academy of Pediatrics to provide wellness care for all children.  Unfortunately, while many insurance plans on the surface appear to save you money, they actually fail to cover all of the typical costs of an office sick visit or well-child checkup.  Important tests, such as hearing, vision, developmental screens, and certain blood tests, may not be covered by insurance.  Likewise, some procedures, including wart treatment, drainage of an abscess, wound repair, and tongue tie clipping, that we perform in the office also have separate fees that may not be covered in full. 

Please understand that we practice medicine based on our extensive training and experience and according to the guidelines of the American Academy of Pediatrics.  If your insurance company has decided that they will not pay for a particular screening, procedure, or vaccination, then the payment will be your responsibility. It is impossible for us to keep track of what each policy covers, and what we recommend for your child is based on standards of pediatric care, NOT the terms of insurance coverage.

Understanding Your Wellness Visit

In an effort to optimize the health of our patients, Twin City Pediatrics recommends regular wellness visits (also known as preventive exams or physicals) per the American Academy of Pediatric guidelines.  But we feel it is important for our patients' parents to understand the difference between what is covered within a Wellness Visit versus a Problem Oriented Visit.

Well-child checkups are comprised of many components, including an assessment of growth and development, screenings for medical and psychological problems, anticipatory guidance to aid parents in the next step of their child's development, a review of the child's vaccination status and updates as needed, and evaluation for participation in school, sports, and camp activities. 

In the course of performing a well-child checkup, parents often mention other concerns about their child's well-being. Many of these are simple questions that can be addressed quickly and clearly fall within the scope of a regular checkup. In some instances, a more significant health problem will be identified at the well-child visit, or a chronic medical issue will be discussed in detail. If so, this additional evaluation your physician undertakes addressing these concerns may go beyond the scope of what is covered as part of a well-child visit. Some examples of such scenarios include:

(1)  The recognition of a new medical problem requiring further evaluation which may include further evaluation which may include diagnostic testing, referral for subspecialty evaluation, and/or a new prescription medication.

(2)  An in-depth discussion of a chronic medical issue requiring a detailed review of the treatment plan and/or a change in treatment or new diagnostic testing.

When these scenarios arise, your physician will generate a billing code for the well-child visit and a "modifier" code indicating that an illness was also treated at the same visit. This is standard billing practice.  In the past, many health insurance plans covered these "modifier" billing codes in full. As insurance coverage has evolved, however, an increasing number of patients are now being asked to pay either the full cost of these modifier billing codes or a co-pay for the modifier portion of the total visit charge.

Due to the comprehensive approach to care taken by Twin City Pediatrics, whenever possible, we try to address problem-oriented issues at the same office visit out of courtesy to our patients' families and to ensure nothing is missed for the sake of the child's well-being.  As a result, services are sometimes performed at the time of a checkup that are both preventive and problem-oriented in nature.  In compliance with insurance company billing policies, this then prompts codes for both categories.  In some cases, your insurance coverage may dictate that you are responsible for a copay or part of the cost of the problem oriented portion of the bill (whereas checkups do not otherwise require a copay). 

We urge parents to call their insurance company to understand what is covered with your policy as every plan differs.  If your insurance company has decided that they will not pay for a particular screening, procedure, or vaccination, or if problem oriented services require a copay, then that payment will be your responsibility. Our care for your child is based on accepted standards of pediatric care, not the terms of insurance coverage.

If you are having financial difficulties and cannot readily pay your bill at Twin City Pediatrics, please contact our Novant billing office. We will be happy to discuss the situation with you to see if we can help you arrange a workable payment plan.