Insurance & Fees

Insurance & Fees

The following is the list of insurances with which we participate. This will be updated from time to time as needed:

  • Aetna – (No HMO Exchange, No ACO, No QHP, No BQA TRS, No Texas Health Resources EPO/HMO, No Smart Care or Image Health)
  • Aetna First Health – (Must say Aetna on card)
  • Baylor Scott & White – HMO, PPO, EPO (Some of our doctors are not yet in the BSW Quality Alliance network, which includes coverage for Baylor employees, BSW or TRS plans, please call our office to verify if your doctor is in network)
  • Beech Street – (PPO only)
  • Blue Cross Blue Shield – PPO, POS, HMO Blue (No Advantage HMO, No MyBlue Health (T2G), No Medicaid)
  • Blue Premier HMO Network
  • Choice Care – (Humana) (No Medicaid, No Humana Exchange)
  • Cigna – Most commercial plans, including Local plus (No Marketplace plans, No Focus BQA, No Medicare plans, No Health Spring)
  • Contigo Health (Formerly Three Rivers Provider Network)
  • First Health – Aetna HAS to be on the insurance card
  • Galaxy Health Network – PPO only
  • HealthSmart Preferred Care (90 Degrees) – Only in network if using Health Smart Preferred Network
  • Humana (Choice Care) – (No Medicaid, No Humana Exchange)
  • MultiPlan/PHCS – (PPO Only, No Discount Cards)
  • Texas True Choice – PPO/POS only
  • TriCare – Tricare for Life, Reserved Select, Select (Out of network with Tricare Prime)
  • United Healthcare/UMR/UH One/UH Shared Services – (No Exchange plans, No Medicaid plans, No Community Plan, No UHC Methodist)

*Medicaid participation is optional and varies amongst Privia Medical Group providers – Forest Lane Pediatrics does not accept Medicaid.

Note: You should always check with your Privia Medical Group provider to verify plan and product coverage as this is not an exhaustive list, and plans change frequently.

Payment Options

We accept cash, Visa, Mastercard, Discover, American Express, and personal checks.

Card-on-File

We encourage patients to keep a credit card on file to make the checkout process easier, faster, and more efficient. You will no longer receive statements from us, but you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier once your claim has been processed, detailing the charges and payments made on your behalf.

At check-in we will:

  • scan the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card

After your insurance has paid their portion, we will:

  • notify you via email of the balance owed
  • charge the balance owed to your card on file
  • email a receipt for the charge

Your credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard – PCI-DSS).

Fees

No Shows
Missed Appointment $25
Missed Physical $25
Late Cancellation $25
No-Show $25
Missed Procedure $200
Out-Of-Network
New Patients Total Charge or Minimum $200 Deposit
Established Patients Total Charge or Minimum $150 Deposit
Self-Pay
New Patients Total Charge Paid at Time-of-Service
Established Patients Total Charge Paid at Time-of-Service
Procedures Total Charge Paid at Time-of-Service

G2211 Code

Coding is the process by which medical offices communicate to insurance companies what services were provided to the patient. These codes are created by the Center for Medicaid and Medicare Services (CMS). A new code – G2211 – has been created for primary care providers who provide longitudinal and comprehensive care.

Unlike urgent cares and emergency rooms that provide “episodic” care, Forest Lane Pediatrics is committed to providing comprehensive care for the “whole” child. This type of care takes more time and a commitment to care for the child both inside and outside of the office. This new code recognizes the extra time and energy needed for this type of comprehensive care and we will be adding the G2211 code to all permitted visits, which includes all patient encounters except for “Well Visits”.

Unfortunately, some insurance companies do not pay for all of the services we provide, despite CMS guidelines. As a result, it is possible that your insurance will deny payment for code G2211 or may pass the charge on to you. We think it is unfair to both us and to you when insurance does this but we do not have any control over how they choose to pay for codes. All we can do is code for our services as instructed by CMS. If you receive a bill for this dode, per federal law, we will not be able to waive the charge. Instead, we ask that you follow up with your insurance carrier directly for reimbursement.

We take great pride in providing your child with the highest quality of care possible. Documenting and coding appropriately for the services we provide is necessary for us to continue to serve our families in this way.

Additional Resources

Avoiding Surprises in Your Medical Bills

Avoiding Surprises in Your Medical Bills (Spanish)

Understanding Healthcare Prices: A Consumer Guide

Understanding Healthcare Prices: A Consumer Guide (Spanish)

Planning For a Medical Procedure