Insurance & Billing
Pediatric Associates (PAGS) accepts most major managed care (HMO, PPO) and private indemnity plans. Prior to your first appointment, please call your insurance company to verify that one of our pediatricians is listed as an in-network provder with your plan. Also, review your insurance policy to understand what services and procedures are covered and which services and procedure may be applied to your deductible. Any questions about the coverage of a service or procedure should be directed to your insurance carrier prior to your visit in our office.
Your care team at PAGS is committed to your health care needs and the billing of your visit is determined by the services and care received, not by the insurance coverage. PAGS providers cannot change billed services to match your insurance coverage.
Since insurance is a contract between you and your insurance company, PAGS does not get involved in any disputes regarding deductibles, co-payments, covered charges, non-covered charges, etc.
Below are descriptions of the typical language used when referring to medical services:
- Preventative Care – This includes services such as physicals (well visit), screening tests, and immunizations that are given when your child is symptom-free and you have no reason to believe that the child might be sick.
- Diagnostic Care – This is what is received when your child has symptoms of an illness or injury (sick visits) or is being followed for a chronic condition; this may include office visits, tests, or treatments.
Preventative and Diagnostic Care can occur at the same visit. For example, your child may have a physical during which a chronic illness is discovered or discussed – some of the tests ordered that day might be preventative, but others might be diagnostic. In most cases, you don’t pay anything for Preventative Care, but you might have to pay something for Diagnostic Care. As always, please call your insurance company with any specific questions you may have about your plan or your level of coverage.
All outstanding payments, including your co-payment, are due at the time of your visit unless other arrangements have been made in advance. You are responsible to pay deductibles as well as charges incurred for services that are not covered benefits of your insurance plan. Self-pay patients are responsible for payment of all charges at the time of service.
For the convenience of our patients, we now accept all major credit cards.
Please call our Billing Department at (978) 741-7812 if you have billing or insurance questions.
Frequently Asked Questions
Q. Do I need my card at each visit?
A. Yes, please bring your insurance card to all appointments.
Q. Is there a co-payment at each visit?
A. Co-payments are dependent upon appointment type and your insurance plan. If your plan requires a co-pay, payment is expected at the time of service. Co-payment are determined by contract between your employer and insurance company.
Q. Are immunizations and blood tests covered by my insurance company?
A. Please call your insurance company to determine your specific benefits.
Q. Do I have to wait a full calendar year between physicals to be covered for the visit?
A. Most insurance companies will cover a physical visit only if 365 days have passed since the last physical appointment. Please call your insurance company to determine your specific benefits.
Q. What happens if I change my insurance company?
A. You need to call them to see if Pediatric Associates participates in your new plan.
Q. Do I need to register my newborn on my insurance plan?
A. Yes, you need to choose and register a primary care provider WITHIN 30 DAYS of your child’s birth.
Q. How do I file a claim for an auto or work-related accident?
A. Provide us with either the auto insurance or workman's compensation form, with all pertinent information included.
Q. Do I need a referral to see a specialist?
A. It depends on the insurer. Please call your insurance company to see if a referral is required.
- Office Phone #: (978) 745-3050
- Office Fax #: (978) 745-7014
- Office Email Address: (General questions and inquiries only, please use the patient portal or call to speak to someone for anything patient specific) email@example.com