Insurance & Billing

BILLING

Please address all billing concerns and questions to our billing company:
CRT
Address: 39625 Lewis Drive, Suite 200, Novi, MI 48377
Phone: (800) 827-3797

INSURANCE

Bloomfield Pediatric Care participates with many insurance companies. Your insurance contract is between you and the insurance company. It is your responsibility to know your insurance plan so you are aware of your financial responsibilities. Do not assume that your insurance company will pay for any services rendered in our office. You will be responsible for any services not covered.  Each employer has a different set of benefits, co-pays, deductibles, and maximums. The billing company we use will be diligent in filing your insurance claim, but we are not responsible for disputes between you and your insurance company. If your insurance does not cover immunizations, we recommend that you go to your local health department. Co-payment is due at the time of service and is your responsibility.

We accept cash, checks and credit cards.

In order to facilitate the billing process:

  • Always bring your insurance card with you to the office.
  • Always retain your receipts and explanation of benefits that your insurance company provides.
  • After the birth of a child, call your employer and inform them so they can place your child on your insurance policy. Most insurance companies require this to be done within 30 days.
  • Some insurance companies will not allow us to do labs in the office. Please advise us of any special restrictions with regards to laboratory benefits or any other office procedures.
  • Call your insurance company first if a claim is rejected.  Most questions regarding non-payment of a claim can be answered by them. It is not our responsibility to mediate a dispute between you and your insurance carrier.
  • Bring your co-pay to the office.  Co-pays cannot be billed and failure to pay at the time of service will result in a $5 service fee. In cases of divorce or other custody / care arrangements, co-pays and deductibles must be collected from the attending parent or caregiver at the time of service.  We are not a party to any divorce agreements. The individual who is requesting medical treatment is responsible for payment.

Many of the insurance companies we participate with are listed below. Please inquire with our office if you do not see yours listed. Changes are made on a regular basis.

Aetna aetna
Assurant Health  Assurant Health
Beaumont  Beaumont
Blue Cross Blue Shield Of Michigan  Blue Cross Blue Shield Of Michigan
Blue Care Network – HMO   Blue Care Network - HMO
Cigna – PPO, HMO   Cigna – PPO, HMO
Cofinity Network  Cofinity Network
Hap (Health Alliance Plan) – PPO, HMO  HAP
Health Plus of MI  healthplus
Humana PPO Humana
Laborers
MEBS Mebs
Medicaid – Straight  Medicaid – Straight
McLaren Medicaid  Mclaren Medicaid
McLaren Health Advantage  Mclaren Medicaid
Meridian Health Plan of MI  Meridian
MultiPlan  MultiPlan
Priority Health   Priority Health
Total Healthcare  Total Healthcare – PPO
TRICARE  TRICARE

How soon should I add my newborn to insurance?

A new parent must inform their employer and insurance carrier of the birth of their child typically within the first few days of life. Failure to do this within 30 days may result in the insurance company assigning a date other than your child’s date of birth as the effective starting date of coverage.  If the insurance is an HMO, remember to list one of our doctors as the PCP (primary care physician).

What is covered by insurance during “Well Visits”?

During the first 24 months, your child will need several routine physical examinations with accompanying immunizations. Verify with insurance whether immunizations are a covered benefit or if they are applied to the “maximum dollar amount” available in your policy.

The best way to determine whether immunizations are covered is to contact your insurance company using the number on the back of your insurance card.. Be sure to ask about well child visits (routine physical examinations) and immunization coverage.  It is important to find out if there is a “maximum dollar amount” allotted for these benefits.  If you reach your maximum benefits, the patient will be responsible for any charges not covered by insurance. If immunizations are not covered, as a cost- saving measure, you may obtain them at the Health Department.

After 36 months, our physicians recommend one annual physical examination each year.  Often insurance plans will pay for one well child visit per year.  Contact your insurance company to determine whether a well visit needs to be scheduled at least  365 calendar days apart or if it is one per calendar year.  It is your responsibility to schedule these appointments and also please note that there would be a $25 cancellation fee if a scheduled well visit is not cancelled within 24 hours prior to the appointment time.

What is an “Office Visit Copay”, “Deductibles” and “Coinsurance”?

Most health insurance policies require co-pays for office visits.  Please read your benefit information to determine if the co-pay is applicable for both well and/or sick visits.  Co-pays are due at the time of service as dictated by the rules of your insurance and we will collect the determined amount during check in on the date of service.

In addition to the office visit co-pay, your health insurance policy may have an annual deductible and or coinsurance (which is an out-of-pocket expense) that must be met by the patient before insurance payment is approved.

Please feel free to contact our billing department with questions or concerns about your insurance.
Phone: (800) 827-3797