Dedicated to providing compassionate, quality care to your special infant

Q: The hospital my baby was in is on my provider list.  Why is my insurance company not paying these charges in full?

A: Our Neonatologists, like many physicians, are contracted separate from the facility in which they practice. In insurance terms, the hospital may be in-network, but our doctor may be out-of-network. If you are noticing that your insurance company is paying your charges at a reduced rate, you were probably considered as out-of-network. Often times if your insurance company is made aware of your specific emergent situation, they may consider additional payment. The appeal process may be as simple as calling your carrier and asking them to reprocess these claims in network. If you need further assistance in the appeals process we would be glad to assist you.

Q: I haven’t received a bill from you. Have you filed my insurance?
(or) I just received a huge bill, have you filed my insurance?

A: If we were delayed in receiving information back from the insurance company, then you will be delayed in receiving your statement. We try not to mail out statements until we are satisfied that we have done all we can to collect complete/correct payment from your insurance.  Sometimes we may not be able to resolve issues with your insurance and you may receive a bill that you believe should have been paid by insurance.  If you receive a statement from us and believe that your insurance has paid incorrectly, it is important that you contact your insurance at this point to dispute their payment.

If on the other hand, you received a statement that does not show any insurance payments, we may be missing simple information. Due to the nature of our practice, for example, patient names may not always be available or may have changed after the claim(s) was filed. Basic insurance information needed to submit a claim includes:

Insurance Name
Claims Address
Policy Holder’s Name and Date of Birth
Patient’s Name and Date of Birth
Patient’s ID#

If you feel that the information we have may be incomplete please contact us.

 My child did not have any complications at birth. Why did I receive this bill?
(or) “Who are you? I’ve never heard of Dr. _____________!!”

A: Often times one of our Neonatologists will be called in to attend a delivery or be involved in the earliest care of your child. A referring physician or staff member would have requested their presence. If you have other concerns about this immediate care, we will be glad to help.

Why should I be responsible for what is considered above the Usual, Customary and Reasonable fees? Why is my insurance company not paying?

A: Most insurance companies have standard rates that they are willing to pay for services rendered. If physicians are contracted with your carrier, it means that they have agreed to these rates. If they are not contracted, the “usual, customary and reasonable” (UCR) rates may vary. The patient is then responsible for the difference.

We strongly recommend you contact your insurance carrier at the phone # listed on your ID card to dispute the UCR limits.

Q: I received a check direct from my insurance, what should I do with it?

A: All payments you may receive belong to the physician who provided the service.  Checks should be marked “pay to the order of Newborn Specialists”, signed on the back, and mailed direct to our office along with any correspondence, such as an Explaination of Benefits (EOB’s), attached.  This will need to be mailed to us within 7 days of receiving the payment.  Although we will work with patients to set up manageable payment plans, payments received direct from insurance are not subject to being placed on a payment plan.


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