Insurance

Insurance, Fees & Vaccines for Children

If you are covered under an insurance plan that we are contracted with (see below), applicable co-payments and deductibles are expected to be paid at the time of service.

Ponderosa Pediatrics currently accepts the following plans:

• Aetna
• AHCCCS
• Arizona Foundation
• ASBAIT
• Blue Cross/Blue Shield
• Bridgeway
• Capstone
• Cigna
• CMDP
• Great West
• Phoenix Health Plan
• Tricare
• United Health Care
• Yavapai Combined Trust
• Yavapai County LTC
• Zenith Administrators

If you don’t see your plan listed above, please call to verify if it has been added. It may be covered by one of the networks we accept. If you are not enrolled and have another insurance plan, we offer a discount for your payment in full and will provide you with a complete receipt that you can send to your plan for your reimbursement.

It is the patient (parent’s) responsibility to know what insurance will or will not pay. We bill insurance companies for services as a convenience to patients. We also verify that a patient is covered at the time of service prior to each appointment. However, this does not guarantee that any claim will be paid. If insurance does not pay for a visit or service, it becomes the patient’s financial obligation.

Understanding insurance can be very difficult, especially for new parents. This information will hopefully help you understand a few things about insurance coverage:

1. Most insurance plans allow 30 days to enroll a newborn or adopted child. Typically, you must contact your insurance company or human resource department to add a newly adopted child or newborn. After this grace period, enrollment becomes much more difficult.
2. If you are insured through an HMO or an AHCCCS plan, your child must be assigned to one of our providers as Primary Care Physician (PCP). The plan may assign your child to another provider in the area if you do not request a provider with Ponderosa Pediatrics. You should contact your plan after a new birth, moving to this area, or changing physicians to our practice to request our provider. Some plans take up to 30 days to assign a new PCP. We cannot see any HMO or AHCCCS patient not assigned to us as PCP.
3. Many insurance plans, including AHCCCS and HMO’s, may require prior authorization for medical services in addition to primary care (us). If your child needs to see a specialist, requires home health or ancillary medical service, our staff will work with you to obtain prior authorization, but keep in mind that some plans take several days to weeks for approval.
4. Most insurance plans have copayments (or copay), deductibles, and/or co-insurance. This is your legal obligation for payment to a contracted provider. By law and contract, no provider can waive, reduce, or negotiate these fees with patients.
5. A copayment is a patient’s “share” of the cost of an office visit in addition to what insurance pays.
6. Coinsurance is a percentage of each claim above the deductible paid by the patient. For a 20% health insurance coinsurance, the policyholder pays for the deductible plus 20% of his covered services. Many insurance companies now add coinsurance for additional services or procedures done during an office visit.
7.  In some instances, these services are applied to an annual deductible. A deductible is an annual amount of charges that must be paid before the insurance kicks in. It is important to be aware that insurance does not always pay for a visit, and what the insurance does not pay is the financial obligation of the patient.
8. At the beginning of each year, many insurance plans send letters asking for information updates on other insurance plans, addresses, phone numbers, etc. You must fill this out and send it back, or your insurance will not pay on any claims. If your insurance does not pay, all fees become your obligation.
9. Ponderosa Pediatrics participates in the Vaccines for Children (VFC) program, and your child may be eligible free immunizations if:
   1. You have no insurance.
   2. You have insurance, but there is no immunization coverage.
   3. Your child is on AHCCCS or Kid’s Care.
   4. You are a Native American.

If you have any questions, please feel free to contact us!