Health Insurance in a New Year: Tips for Billing Efficiency

As you plan for 2023, your pediatrician’s office would like to ensure the simplest billing process for health services your child receives in the coming year. Whether you’re keeping the same policy through an employer or you recently participated in open enrollment on the state exchange, some practical tips are always helpful to your family and our practice.

Bring your child’s current insurance card to every appointment. It’s never a bad idea to have a physical copy of the card on hand, even if it’s the same as your last visit.

Please return any communication from our office promptly. If your pediatrician’s office contacts you for any follow-up, including billing, please get in touch soon. Insurance companies have timely filing limits, which require us to submit claims within a determined window of time from any services. Your cooperation helps us bill with optimal efficiency.

With this in mind, we also strongly encourage you to do the same for your insurance provider. If they contact you, return their call or request as soon as you can.

Complete and return any supplementary forms. If you have primary and secondary health insurance, you will likely receive a form titled “Coordination of Benefits.” You must complete and return this form as instructed. This allows your insurance providers to coordinate responsibility for your medical services. Without it, you may accumulate unnecessary charges.

Review your benefits. Whether you’re keeping the same policy or starting the year with a brand new one, it’s wise to know the basics of your policy. Such as:

  • Which services are free, and which have a co-pay. Most health insurances fully cover an annual well visit for anyone on the plan. Copays can vary for a sick visits, follow-ups, specialist appointments, and urgent settings. Generally speaking, primary care settings are the most cost-effective. Even the simplest of emergency room visits can cost hundreds of dollars. Unless your child is exhibiting serious symptoms, call your doctor’s office first. Insurance companies also closely track their members’ medical expenses to set premium costs and coverage limits in subsequent years.
  • Your deductible and out-of-pocket maximum. If you pay for services throughout the year and reach these amounts, you may be able to squeeze in additional in-network services at no cost at the end of the calendar year, such as allergy testing or a multi-month medication supply. Keep in mind that many employers offer high deductible health plans in today’s expensive market, which keep your monthly premiums lower but set your deductible high.
  • Medication costs. Even if you keep the same health insurance year to year, prescription costs may have changed. Find out what you can expect to pay for your daily prescriptions, and if you find that any medication is outside your budget, call us right away. We will work with you to get medicine you can afford. It’s much better to get a slightly different prescription than not to take a medication at all.
  • “In-Network” providers. Insurance companies use networks of preferred physicians and facilities. If your insurance has changed, please let us know as soon as possible.

If you have questions or concerns, let us know! Your ONE Pediatrics practice and physicians want you to receive the best and most efficient care with as little insurance headache as possible. We look forward to caring for your child in the new year.