Aetna and Aetna-leased network participation update (3/13/19)
Effective June 12th, 2019 ABC Pediatrics will no longer be an in-network participating pediatrics medical practice with Aetna or Aetna-leased insurance plans.
We have made this difficult choice based on a decision made by Aetna at the end of 2018. In their general wisdom (sarcasm intended), highly-paid Aetna executives decided that the care provided to your children is valued less than the care provided to other patient populations and unilaterally capped reimbursement rates for care provided to half of the market norms -- no matter what the level of care provided.
We were informed by Aetna that this is a decision that is affecting pediatricians countrywide. We tried to hold out and renegotiate our reimbursement rates, but Aetna will not budge.
You will be receiving a letter from Aetna regarding our non-participating status. We would love to continue seeing your children, but be aware that we will no longer accept assignment as an out-of-network office and will require you to sign a new Conditions of Treatment form acknowledging understanding of the above stated terms.
Should your family choose to transfer to another pediatric office (if there are any left and taking new patients given the circumstances), we will make your records transfer as seamless as possible. To do so, please fill out our Release of Information form and return it to us. There is no charge for a records transfer to another medical office (for the first time) and thereafter a fee of $25* + $0.10 per page will be due prior to subsequent records release. This same fee will also apply to receive a copy of your child's records for personal use.
* per child
We have made this difficult choice based on a decision made by Aetna at the end of 2018. In their general wisdom (sarcasm intended), highly-paid Aetna executives decided that the care provided to your children is valued less than the care provided to other patient populations and unilaterally capped reimbursement rates for care provided to half of the market norms -- no matter what the level of care provided.
We were informed by Aetna that this is a decision that is affecting pediatricians countrywide. We tried to hold out and renegotiate our reimbursement rates, but Aetna will not budge.
You will be receiving a letter from Aetna regarding our non-participating status. We would love to continue seeing your children, but be aware that we will no longer accept assignment as an out-of-network office and will require you to sign a new Conditions of Treatment form acknowledging understanding of the above stated terms.
Should your family choose to transfer to another pediatric office (if there are any left and taking new patients given the circumstances), we will make your records transfer as seamless as possible. To do so, please fill out our Release of Information form and return it to us. There is no charge for a records transfer to another medical office (for the first time) and thereafter a fee of $25* + $0.10 per page will be due prior to subsequent records release. This same fee will also apply to receive a copy of your child's records for personal use.
* per child
Aetna and Aetna-leased network participation update (2/20/19)
Effective April 1, 2019* ABC Pediatrics will not be accepting new patients that are covered under the following plans:
- Aetna (including Altius, Cofinity, First Health and Meritain Health)
- Aetna leased network Third Party Administrators (e.g. Allied Benefit Systems Inc, Strategic Resource Company)
*For families that have established care with ABC Pediatrics prior to April 1, 2019 and are already insured by an Aetna or Aetna leased plan, we will continue to participate with your insurance as an in-network office. Future participation with Aetna as a whole is under review. If you have questions about your coverage and/or why ABC Pediatrics is making this change, please contact us through our billing questions form here.
We Accept Most Health Insurance
Many of the services provided in our office are covered and paid for by your insurance company. As a courtesy to our patients we will send claims to your insurer for processing. All services are rendered to our patients and not their insurance companies and therefore all charges are the financial responsibility of the insured and not the insurance company, regardless of your insurance coverage.
We expect your insurance to process and pay claims within thirty days of receipt and, if this has not occurred, we may ask for your assistance to rectify any delays in processing or payment.
As per our contractual agreement with your insurer, payment of insurance co-payments as detailed by your insurance plan benefits is required at the time of your visit. Failure to pay your co-payment will incur a $10 surcharge on your account.
Upon receipt of an Explanation of Benefits (EOB) by our office, co-insurance, deductibles and any responsible party balances will be due immediately (see Payment & Credit Card Policies). You will not be billed for contractual allowances.
We expect your insurance to process and pay claims within thirty days of receipt and, if this has not occurred, we may ask for your assistance to rectify any delays in processing or payment.
As per our contractual agreement with your insurer, payment of insurance co-payments as detailed by your insurance plan benefits is required at the time of your visit. Failure to pay your co-payment will incur a $10 surcharge on your account.
Upon receipt of an Explanation of Benefits (EOB) by our office, co-insurance, deductibles and any responsible party balances will be due immediately (see Payment & Credit Card Policies). You will not be billed for contractual allowances.
At present, we are contracted with the following insurance companies:
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It is the absolute responsibility of the insured (member) or the parent using the insurance policy to
know their own coverage benefits and eligibility in addition to whether our office is a participant in their specific plan.
know their own coverage benefits and eligibility in addition to whether our office is a participant in their specific plan.
Please refer to your insurance plan guide, website or call your insurance plan customer service agent regarding questions you may have pertaining to plan participation, benefits and eligibility.
