We realize that understanding your insurance benefits can be a complicated and frustrating issue. Rest assured that we have many difficulties with collecting from insurance companies. Our staff has grown by two members, just to deal with these issues. It is our experience that most of the problems do not originate with us.

Likewise, many families have questions about their benefits and they way charges are assessed and assigned by your insurance. Please remember that we are not an agent of your insurance company. If there is a problem with payment, assignment of benefits, rates of reimbursement for services, or coverage of any particular procedure performed at our office, it remains your responsibility to call the customer service line listed on your insurance card. It is not our responsibility to clarify your benefits or negotiate with the insurance company.

When benefits have been assigned, there are often payments due that are in excess of your copay. As insurance companies find more and better ways to avoid payment, the number of small charges that accumulate become more and more frequent. We all know that insurance companies now require larger and larger deductible amounts for various services. While your copay may cover the basic medical portion of the visit, the so-called “evaluation and management” of the problem, there are laboratory charges, vaccine costs, and items we consider reasonable and necessary that are classified as “procedures” that are not covered at all or may be covered at a reduced rate. An example of this is “coinsurance” charges. While not specifically called a “deductible” charge, it is often assessed as a percentage of the allowable amount for that particular service.

Please be aware that each patient or responsible parent has signed an agreement with The Children's Clinic that first assigns payment to us, and then acknowledges financial responsibility for charges that are not covered by insurance. If you receive a bill from us which you dispute, please discuss the issue with your insurance company's customer service or your insurance agent. Payment to us is due, in full, at the time of service. We will wait for any payments from insurance companies before sending out a patient bill, but any balances are due immediately. If we later determine through a revised “Explanation of Benefits” from your insurance company that they have led us to bill you in error, we will happily refund your money.

In the event insurance does not pay for services, we have five years from the date of service to bill and collect for these services under Kansas Law. Each responsible party has signed an agreement with our office accepting liability for all legitimate charges incurred in our office.

Thank you for your understanding and cooperation in keeping quality medical services available for children in Miami County.