Midlands Pediatrics, P.C.  
     
     
Frequently Asked Questions
Frequently Asked Questions



Patient Financial Policy
 

Ai Lan Kobayashi, M.D.
Midlands Pediatrics, P.C.
401 E. Gold Coast Road, Suite 325
Papillion, NE 68046

Tel. 402-592-1700 Fax: 402-592-3335


PATIENT FINANCIAL POLICY

Thank you for choosing our practice! We appreciate your confidence in our commitment in providing the best and most up-to-date health care to your children. In addition to the brochure you received upon your first visit to our office that explains our operations, we have prepared this pamphlet to answer the most frequently asked questions about fees, insurance claims and payments. If you need further information about any of these questions and answers, please feel free to contact our billing service (Midwest Medical) at 402-709-0063.

WHICH INSURANCE PLANS DO YOU TAKE?
We participate with most insurance plans that offer health insurance in Nebraska and Iowa. United Healthcare, Blue Cross Blue Shield, Coventry, Midlands Choice, and Nebraska Medicaid are some examples. The list may change from time to time, so if you are not sure that we are a "participating" or "preferred" or "in-network" provider, please call our office at 402-592-1700. We may be listed as either "Ai Lan Kobayashi, M.D." or "Midlands Pediatrics" under "Omaha", "La Vista", "Papillion", or "Sarpy County" in your insurance plan's booklet.

WHAT DOES MY INSURANCE PLAN COVER?
You need to study the materials provided to you by your health insurance plan. You should know what types of visits and services are covered, what is the amount of your deductible per year (both per child and per family), what is the amount of your copay for each visit, what is the maximum limit per year for each child's well-baby exams or routine physical exams.

WHAT SHOULD I BRING TO EACH OFFICE VISIT?
You should always bring your most current insurance card and your copay, if there is any. You should also make sure that "Ai Lan Kobayashi, M.D." or "Midlands Pediatrics, P.C." is on the line for "Primary Care Physician".

WHO WILL SUBMIT THE INSURANCE CLAIMS?
Our billing service will submit the charges for your child's visit on your behalf to your insurance company. Working with insurance companies is like trying to find your way out of a complex maze, so this is a very valuable service we provide to you as a courtesy. Please remember, however, that your health insurance is a contract between you (via your company's benefit plan) and the insurance plan you chose. Any charge incurred from your child's visit is ultimately your responsibility.

WHAT HAPPENS AFTER THE INSURANCE CLAIMS ARE SUBMITTED TO MY INSURANCE COMPANY?
Your insurance company may take anywhere from 2 weeks to 8 weeks to process the claims. After they have finished with this step, they will send you and our office an "Explanation of Benefit" form ("EOB") explaining what they have decided to pay, based on your contract. The EOB will show you how much of the charges was "covered" by the insurance, how much of that "covered charge" was paid directly to our office, and how much will be your responsibility (due to copay, co-insurance, deductible, or non-covered services, etc.). Occasionally, your insurance may ask you to provide some additional information before they process your claim. Please answer their questions promptly; otherwise they will not process the claim, and the entire bill will be your responsibility.

WHAT HAPPENS AFTER THE EOB IS RECEIVED?
You will see how much is your responsibility, and we will send you a statement during the same month that you receive the EOB. Please pay your balance as soon as possible. We will send you a total of 3 statements over the course of approximately 2 ½ months.

WHAT IF I DO NOT PAY MY BALANCE?
If you do not send any payment, or make payment arrangement with the billing service after the 3 statements, you will receive a notice that your account will be turned over to the collection agency. If your account must go to the collection agency, we will request "cash payment only" at your child's next visit. An additional 30% to 50% (the service fee that the collection agency charges our office to collect your balance) will also be added to your balance. To avoid this additional charge, please be sure to contact our billing service to make payment arrangement as soon as you receive the "final notice".

IS THERE INTEREST CHARGED ON OVERDUE BALANCES?
Beginning January 1, 2006, there will be an interest charge on your balance at the rate of 16% per annum if it is not paid within 30 days from your first statement, as allowed by federal and state laws. The amount of the original balance, interest, and new balance will appear at the bottom of your statement.

HOW MAY I PAY MY BALANCE?
We accept cash, check, VISA, and MasterCard.

WHAT IF I AM HAVING FINANCIAL HARDSHIP?
Please contact our billing service for assistance.

WHAT IF I HAVE NO HEALTH INSURANCE?
You will be responsible for the entire amount of charges incurred from your child's visit. Please contact our billing office for assistance. We will also provide you with information regarding community resources that you might contact for further assistance.

WHAT IF I HAVE MORE THAN ONE HEALTH INSURANCE PLAN?
Please bring all insurance cards to each visit.

WHAT IF I NEED A REFERRAL?
Depending on your insurance plan, you may need a referral or prior authorization to see a specialist (such as a surgeon or dermatologist), or to get X-Rays or laboratory tests at a hospital. Make sure that these doctors and hospitals are within your network; otherwise you will be responsible for the entire bill. If your child has a medical emergency and needs to be seen at an Urgent Care Center or an Emergency Department after office hours, you may have to contact Dr. Kobayashi before going to such facility to obtain prior authorization.

WHAT IF I AM UNABLE TO TAKE MY CHILD TO SEE THE DOCTOR?
A parent or legal guardian must accompany patients who are under 18 years of age on their first visit. This accompanying adult is responsible for payment of the account, even if he or she is not the insurance policy holder. For subsequent visits, the parent or guardian can provide a written permission to have another adult bring the child to the office. We will see patients who are 16 years or older without the parent, provided a parent or legal guardian has called our office regarding the appointment, or if the patient needs to discuss a confidential health-related matter without needing parental consent as allowed by federal and state laws.

WHAT IF I MISSED THE APPOINTMENT?
If you cannot keep the appointment, we ask that you kindly call the office to cancel the appointment at least 24 hours prior to the appointment. If no cancellation notice is received, your account will be charged a $10.00 "no-show" fee.

WHAT IF I NEED SOME FORMS TO BE FILLED OUT FOR MY CHILD?
For school physicals, school medication authorization, and other forms required by schools and/or day care providers, there will be no charge if these forms are brought to the office at the time of the visit, or within 2 weeks of the visit. Otherwise, there will be a $10.00 fee for each form.

WHAT IF I WISH TO TRANSFER MY CHILD'S RECORDS TO ANOTHER PHYSICIAN?
There is no charge if only immunization record or a summary of your child's care at our office is prepared and sent to the indicated facility. However, if you require copies of the entire health record, there will be a fee for copying as allowed by state laws.






October 2005

Ai Lan Kobayashi, M.D.
Midlands Pediatrics, P.C.
401 E. Gold Coast Road, Suite 325
Papillion, NE 68046

Tel. 402-592-1700 Fax: 402-592-3335


PATIENT FINANCIAL POLICY


I have received and read Midlands Pediatrics' Patient Financial Policy. I understand and agree that charges not covered by my insurance company, as well as applicable copayments and deductibles, are my responsibility.

I authorize my insurance benefits to be paid directly to Midlands Pediatrics, P.C.

I also authorize Midlands Pediatrics, P.C. to release my child's pertinent medical information to my insurance company when requested, or to facilitate payment of a claim.

I agree to notify Midlands Pediatrics, P.C. immediately of any change in my insurance.


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Signature of Parent or Legal Guardian Printed Name

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Relationship to Patient Date