Forms & Policies

Insurance & Billing at Elmwood Pediatrics

Our Rochester, NY practice participates with most products of the following insurance companies:

  • Aetna
  • Blue Cross/ Blue Shield Plans 
  • Cigna
  • Empire Plan (NYSHIP)
  • Excellus Plans
  • MVP Health Ins
  • Lifetime Benefit Solutions
  • United Health Care
  • Univera
  • Your Care

We do not accept/participate with: Fidelis, Blue Cross of Western NY, PHCS/Multiplan.

Please Note: Elmwood Pediatric Group is an independent practice that does not offer charity care. Please call your insurance carrier if you have questions about our participation in your health insurance plan. We will submit claims for many other private plans. Participation in these plans may change without notice. Our billing office number is 585.244.9841, which serves both practice locations.

We give equal access to excellent care regardless of insurance type.

We are a member of Accountable Health Partners (AHP).

Please check your insurance - Please check your insurance coverage for labs, X-rays, referrals and all medical visits. We can help you find out where to look for this information. Also please search the insurance websites or call the insurance companies.

The websites listed at the bottom of the page may be helpful to you, and the document below has helpful information. Thank you for your attention to this important matter.

Patient Lab and Radiology Referrals

Financial Policy

We are committed to providing you with the best possible care and are pleased to discuss our professional fees with you.  Your clear understanding of our Financial Policy is important to our professional relationship.  Please let us know if you have any questions. You may contact our billing office at 585-244-9841.

All patients will be required to fill out a Patient Registration form prior to seeing the provider.  As part of our commitment to have current and accurate information on file we will request that you review the demographic and insurance information we have on file at every visit.  The insurance card will be scanned into our computer system for future reference.  

 The following information will help you understand our financial policies:

Co-Payments

Your insurance REQUIRES that we collect your designated co-payments at the time of service.  Please be prepared to pay the co-payments at the time of check-in.  

Deductibles and/or Additional Co-Payments

There may be times when your insurance determines the care you are receiving is to be paid through your deductible/coinsurance plan or that a co-payment should be deducted for the care provided.  You are responsible to pay these charges. Effective January 1, 2015, we will request a deposit ranging from $82.08 and up for services that fall under the patient’s deductible/coinsurance plan.  Please review your insurance handbook and be aware of what your insurance offers for benefits.  When in doubt contact your insurance company directly for clarification.  You are responsible for the charges that fall under your deductible/coinsurance and/or copayment plan.  In addition, you will also be responsible for services that are not covered by your insurance plan.  In these situations we request that full payment be sent immediately when notified by your insurance carrier.

Processing Fee

There is a $15 processing fee for any unpaid co-pay and/or deductible deposit not paid at the time of your visit.  Chronic non-payment can constitute discharge from the Practice. 

Self-Pay Payments

All Self-Pay patients and patients who present without insurance information are required to pay an upfront deposit of $160.00 for routine physicals and $110.00 for acute illness visits.   The balance, if any should be paid at the time of check-out.

Non-Sufficient Funds

All checks returned for non-sufficient funds will be charged an administrative processing fee of $25.00.

Request for Copies of Medical Records

The first request for a copy of the medical records to the patient will be at no charge.  Subsequent requests will be at the current New York State maximum rate of $.75 per page plus postage.  Copies of medical records to other than the patient may be subject to a charge at the New York State maximum rate of $.75 per page plus postage.

Types of Payment

We accept Cash, Checks, Money Order, Visa, MasterCard, American Express and Discover cards as forms of payment.

No Show/Cancellation Policy

We request that at least 24 hour notice be given to cancel or reschedule an appointment. If proper 24 hr. notice is not given the first no show/cancellation will result in a “warning” letter, the second no show/cancellation within 12 months will result in a fee of $50.00 fee for a pre-scheduled appointment (physical, recheck, consult, etc.), a third no show/cancellation within 12 months can result in being discharged from the practice.  If you are more than 15 minutes late for your appointment, you may be asked to reschedule your appointment.

Contact Phone Numbers

We will utilize all home/cell phones numbers provided to EPG to contact the patient/guardian for the following reasons:

        - All outstanding balances including any insurance or billing questions or issues

 

Insurance Websites

Insurance Website Phone #
Aetna https://www.aetna.com/individuals-families/member-rights-resources/member-services.html # on back of card or 1-800-US-AETNA (1-800-872-3862)
Cigna http://www.cigna.com/ # on back of card or 1-800-997-1654
Empire Plan http://www.empireplanproviders.com/ 1-877-7NYSHIP (1-877-769-7447), choose UnitedHealthcare
Excellus https://excellusbcbs.com/wps/portal/xl/mbr/ # on back of card or 1-800-499-1275 
Independent Health https://www.independenthealth.com/IndividualsFamilies.aspx 1-800-501-3439
Medicaid NYS http://www.health.ny.gov/health_care/medicaid/ Your caseworker or Medicaid Helpline 1-800-541-2831
Your Care http://www.yourcarehealthplan.com/ # on back of card or 1-800-683-3781
MVP https://swp.mvphealthcare.com # on back of card or 1-888-687-6277
RMSCO http://www.ebsrmsco.com/contactus/office-locations.aspx # on back of card or 585-421-4400
United Healthcare https://www.myuhc.com/member # on back of card or 1-866-633-2446
Univera https://univerahealthcare.com/wps/portal/uv/mbr/ # on back of card or 1-800-499-1275 

Immunization Policy

Vaccines save lives by preventing disease.  All of the medical professionals at EPG are strongly in support of protecting children’s health by giving them vaccines which prevent infectious diseases.   Although we are willing to work with families who have concerns about vaccine efficacy and safety, we feel that parents who are opposed to vaccine administration to their children need to seek pediatric care from providers who have similar philosophies.   We follow the recommended schedule from the Centers for Disease Control and the American Academy of Pediatrics.