Durbin Creek 904-5190008
135 Durbin Station Court suite 503 St Johns Fl 32259
College 904-6448669 :
430 College Drive Suite 100-102 ,Middleburg Fl 32068
Navigating Your Child's Health Insurance
Insurance Accepted by EXCEL Pediatrics
Allied Benefits - 1-800-288-2078
Florida Healthy Kids - Ages out at 18
Med 3000 Title 21
Mission Point - 1-855-529-5762
Pedicare Title 19
For all patients on our participating plans, your co-pay and/or deductible amount will be due at the time of service. As a courtesy our office will file your claim with the patient’s insurance company; however our relationship is with you and not your carrier. If the patient is a minor, the parent/legal guardian is financially responsible for all charges incurred in the care and treatment of the patient. The patient is responsible if the patient is 18 years of age or more. Payment for any amount not covered after insurance reimbursement is due upon receipt of your first statement. Please consult with your insurance company member services department regarding specific benefits and coverage. Payment of co-pays and deductibles and co-insurance is expected at the time of service.
The following is helpful information about insurance and answers to some of our frequently asked insurance questions.
• Always bring your insurance and picture ID to every visit
• Know the patient’s benefits and co-pay amount
• Know the name of the patient’s Primary Care Physician (PCP)
• Know the effective date of the patient’s current policy
• Know if the patient needs a referral to see a specialist or to obtain an x-ray
Frequently Asked Questions
Q: Can the patient be seen without an insurance card?
Q: How do I know who a balance is for if multiple family members come to the practice?
A: The patient’s name is listed on the statement you receive from the practice.
Q: What is an Insurance Balance?
A: A visit that has been filed with the patient’s insurance company and is pending payment.
Q: What is COB?
A: COB stands for Coordination Of Benefits. Most insurance companies send out a yearly questionnaire inquiring if the patient has any other insurance coverage. If you do not reply or if the patient’s insurance carrier thinks there is additional coverage the patient’s claims will not be paid until the insurance carrier is contacted the requested information is provided. We are unable to resolve this probably for you... only the policy holder can provide the information required by the patient’s insurance carrier. Until the problem is resolved, if the patient is a minor, the parent/legal guardian is financially responsible for all charges incurred in the care and treatment of the patient. The patient is responsible if the patient is 18 years of age or more.
Q: What is EOB?
A: EOB stands for Explanation of Benefits, and is generated by the patient’s insurance company. AN EOB provided necessary information about the patient’s claim payment and patient responsibility amounts that are due and payable to the practice. If you have any questions about the information provided on the EOB please contact the insurance carrier.
If the patient’s insurance carrier is not listed above or if you have other questions regarding insurance or coverage please contact our Billing Department at 904-519-0711.
Q. What happens when a patient reaches an age of maturity and should be seen by a Family Practice or Internal Medicine provider, instead of a Pediatrician?
A. The Practice routinely cares for children from birth until 18 years of age. Special exceptions are made on an individual basis for children whom the provider deems it appropriate to remain with the Practice AND the contract with the patient’s insurance carrier allows for the continued association; and for children with special health care needs whose coverage may be extended until age 21. Routinely when a patient is 17 years of age (UNLESS patient is going to continue care with the Practice based on exceptions shown above), a letter will be sent that will begin to open the dialogue with the patient regarding transfer of care to an adult-oriented PCP and provide them with the Authorization for the Release of Protected Health Information form. Patients will be provided with the website information for each insurance company that participates with the practice. It will be recommended that the patient visit the website of the appropriate insurance company to locate a new PCP (either Internal Medicine or Family Practice) based on their geographic location and personal needs. In addition we will recommend all female patients to select a gynecologist from the appropriate website. This website will also include participating area hospitals. Patients who are seen in the office during the year of their 17th birthday will be provided the letter and information at that visit.