Insurance & Billing

PAGS accepts most major managed care (HMO, PPO) and private indemnity plans. However, due to ever changing insurance coverage, it is extremely difficult for us to know the individual requirements of each specific insurance plan for every patient.  Our medical providers are experts in delivering first rate medical care to your child (not insurance plans).
 
Insurance is a contract between you and your insurance company. It is the parent/guardian's responsibility to confirm that your insurance carrier and policy is contracted with PAGS and understand the specific terms of your coverage.
 
Prior to your first appointment, please call your insurance company to verify that one of our pediatricians is listed as an in-network provider with your plan. You should be familiar with which services and procedures are covered (i.e., lab work, x-rays, hospitalization, immunizations, etc.) and which may be applied to your deductible. All co-payments, by contract, must be paid at the time of your visit.
 
Your care team at PAGS is committed to your health care needs. 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 and PAGS does not get involved in any disputes regarding deductibles, co-payments, covered charges, non-covered charges, etc. 
 
If your insurance plan requires a referral to see a specialist, you must coordinate the referral prior to the appointment with the specialist. In many cases, your insurer will require that we see your child before we can issue a referral.

Insurance Policy

Below are descriptions of the typical language used when referring to medical services:

Any questions about your coverage should be directed to your insurance carrier prior to your visit. It is important that you communicate directly with your insurance company regarding specific questions you may have about your plan or your level of coverage.

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. 

Insurance Plan Information

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.

There will be a $150 no show fee for appointments canceled less than 24 hours for ALL appointments, including Behavioral Health visits.

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.

We are still scheduling virtual visits, however, depending on your insurance plan, there may be a copay, co-insurance, or a deductible.

What this means to you? If you have a virtual (video) visit scheduled with our office, please contact your insurance to verify your benefit.  If you are given a reference number, contact with our billing department 978-741-7812. You are responsible for the balance that your visit generates.

Billing Policy