Frequently Asked Questions
We try to anticipate questions you might have about our PRODUCT / SERVICE and provide the answers here. If you need additional information send email to firstname.lastname@example.org
Q: Do you take my insurance?
It is impossible to know if we take EVERY plan (because there are plans within plans now-a-days). Please call your insurance carrier and give them our NPI# (National Provider Identifier) which is: 1336363795. Ask if Lisa Caso DO, or TenderCare Pediatrics comes up as IN NETWORK for your plan. This is the BEST way to get the answer you need. We will not be held responsible for checking this for you. It is YOUR responsibility
to check prior to coming in for an appointment. We DO NOT
take any medical assistance plans, and there are only a couple of CHIP plans that we take. You are welcome to come to our practice even if we don't take your insurance as a cash paying patient. We do offer discounts!
Q: Why did I get charged for a copay and/or Deductible when my insurance covers well visits?
Under instruction from the American Medical Association
and the Center for Medicare and Medicaid Services (www.CMS.gov)
, if any abnormalities or pre-existing problems are discovered and addressed during a preventative exam, it can be separately billed to your insurance. Therefore, if a Urine dip or Hemoglobin done at your visit comes back abnormal, there may be further work up and planning. It is very important to run these tests as they show things like Anemia, and abnormal kidney function, or infection. Abnormalities such as heart murmur, delayed milestones, or behavioral issues are examples of issues that may come up in a well visit, which would then be billed as additional work up. These are just a few examples of a multitude of possible issues. A "sick" and a well visit are BOTH billed in this case. (even though it may not technically be a "SICK" visit.)
Q: My statement says I need to Coordinate my Benefits, what does that mean?
On occasion your insurance company may question whether you have any other insurance coverage. They will often send you a form to complete and send back. These forms often get missed, and then the insurance stops paying for your visits until you complete the form or contact them. The EASIEST and FASTEST way to do this is to CALL THEM to let them know whether or not you have any other insurance.
Q: If I think there is an error on bill, is it ok to wait until my next appointment to bring it up?
No. Please call the office as soon as you get the bill if you think there is an error, or you have any questions about the bill. Failure to take care of questions or resolve the issue may cause your account to have additional fees added after 30 days!! (as per the financial policy set forth 1/1/16)
Q: Is it ok to wait until my next visit to pay a bill?
Not unless your next appointment is within 30 days of receiving your statement. If statements are not paid within 30 days, a fee will be added. (as per the financial policy set forth 1/1/16)
Q: Is there anything special I need to know about adding my newborn to my insurance?
Your newborn is covered under the mother's insurance for the first 30 days only. During that first 30 days you will need to make sure the baby gets officially added as a new member to your insurance policy. You would do this by contacting the insurance company directly or by contacting the subscriber's employer if that is where the insurance plan is purchased. If you do not add the baby before the first 30 days is up there may be a lapse in coverage, which means you may get a bill.
Q: What does "Maximum Benefits Reached" mean on my statement?
This usually means that your insurance company only covers a certain number of well or sick visits per year, and you have reached that limit and gone over it. This varies by insurance carrier. If you follow OUR vaccine schedule, you may have 1 or 2 visits in the first 2 years of life that some insurance companies do not cover because our vaccine schedule is slower then some other practices. Please contact your insurance company directly if you think this is on a statement in error. The billing department must follow what your insurance company tells them to do when it comes to billing you.
Q: Why did I get a bill for a sports or driver's permit physical?
Most insurances do not cover more then one well exam per year. If you need an additional exam to participate in sports, or to get a drivers permit, your insurance company may not cover it. If there is no abnormalities found upon exam these are billed out as "sick visits" with a diagnosis code that states it was an exam for sports or "other administrative purposes". Please contact your insurance company directly to find out if these exams are covered.
Q: Why is a weight check not counted as a well visit for my newborn (therefore I have to pay a copay/deductible/coinsurance)?
Insurance companies only cover a certain number of well visits within the first 2 years of life. Weight checks are very important in order to make sure that your newborn is gaining weight properly the first couple of weeks. These checks are billed as "sick" visits (even though the child may not be sick, that is what it is categorized as). These visits are part of OUR protocol, which may vary from other offices. But we feel it is vitally important for your newborn.
Q: My insurance is changing, how do I know if you take it?
Please call your new Insurance company and give them our NPI (National Provider Identifier) number which is: 1336363795. They will be able to tell you if our Group Name (TenderCare Pediatrics) or Dr. Lisa Caso's name comes up as "In Network". Because there are SOOOO many plans, it is impossible to tell if you take your individual one. Calling the insurance is the best way to be sure.
Q: Why do I have to pay a copay for my flu shot/mist, since its preventative?
If you get your flu Shot/Mist at a visit that is OUTSIDE your normal Well visit, then it gets billed as a low level "sick" visit because Dr. Caso, herself, is administering the shot. When a PHYSICIAN administers a vaccine, it is considered an office visit, and the insurance instructs us to bill a copay. Other offices may have nurses give these, and they may not bill an office visit. Dr. Caso is solo, and so she does everything herself.
Q: Why is my deductible higher for some visits than others?
Depending on the complexity of the visit, a higher visit code may be used. You can always call your insurance to check what your deductible might be for a normal office visit (procedure code 99213) or a higher level visit (99214) If you are an established patient. We do not bill you higher then the insurance tells us to.
Q: Can I be billed for my copay if I forget my wallet?
No. Payment of cash or credit card is expected at the time of service. We do not accept checks for copays paid in the office. Checks are only
accepted when paying a statement you mail in.
Q: If I come in for an appointment and I have a balance, but I can't pay it, will I be seen?
All account balances must stay below $150 in order to stay current with the practice. We can set up a written payment plan, if needed, at the time of the visit, but some sort of good faith payment must be made in order to be seen.
Q: Do you offer discounts for people who don't have insurance?
Yes we do! Cash paying patients must pay at the time of service without exception.
Q: I have a form that needs to be filled out for daycare or school, can you fill it out right away?
There are certain requirements in order for forms to be filled out. First, the child must be up to date with their well visits. Second, if there is an outstanding bill, it must be paid prior to any form being filled out, and third there is a $5 fee that must be paid for the form to be filled out. Dr. Caso is usually able to fill forms out within 24-48 hours after they are dropped off.