Billing & Insurance
Our practice participates with most products of the following insurance companies:
- Blue Cross/ Blue Shield Plans
- Empire Plan (NYSHIP)
- Excellus Plans
- Blue Choice Option
- MVP Health Ins
- Lifetime Benefit Solutions
- United Health Care
- Your Care
We do not accept/participate with: 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 care regardless of insurance type.
We are a member of Accountable Health Partners (AHP).
Please check your insurance – Please check with your insurance company for details regarding coverage for labs, X-rays, referrals and medical visits.
The websites listed at the bottom of the page and the document below may be helpful to you.
Thank you for your attention to this important matter.
To view the forms listed below, you will need to download Adobe Reader.
We are committed to providing you with the best care possible and are available to discuss our professional fees with you. Your clear understanding of our Financial Policy is important to our professional relationship. If you have any questions, please contact our billing office at 585-244-9841.
All patients will be required to fill out a Patient Registration form prior to seeing a provider. We are committed to maintaining current and accurate information on file, thus we will ask that you review this information at each visit. Your insurance card will be scanned into our computer system for future reference.
The following information will help you understand our financial policies:
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.
There is a $15 processing fee for any co-pay and/or deductible deposit not paid at the time of your visit. Recurrent failure to make payments may result in discharge from the Practice.
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.
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.
Patients may utilize our online billpay portal to pay their balance from our website.
No Show/Cancellation Policy
We request that at least 24 hour notice be given to cancel or reschedule an appointment.
If proper 24 hour 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.)
- The 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
Aetna – # on back of card or 1-800-US-AETNA (1-800-872-3862)
Cigna – # on back of card or 1-800-997-1654
Empire Plan – 1-877-7NYSHIP (1-877-769-7447), choose UnitedHealthcare
Excellus – # on back of card or 1-800-499-1275
Independent Health – 1-800-501-3439
Medicaid NYS – Your caseworker or Medicaid Helpline 1-800-541-2831
Your Care – # on back of card or 1-800-683-3781
MVP – # on back of card or 1-888-687-6277
Lifetime Benefit Solutions – # on back of card or 585-421-4400
United Healthcare – # on back of card or 1-866-633-2446
Univera – # on back of card or 1-800-499-1275
No Surprises Act
- Right to Receive Good Faith Estimate of Expected Charges Notice
- Your Rights and Protections Against Surprise Medical Bills
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost
Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least one business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good FaithEstimate, you can dispute the bill.
- Make sure to save a copy or picture of your Good Faith Estimate.
For Questions or More Information
About Your Right To A
Good Faith Estimate:
or call the Elmwood Pediatric Group Billing Department at 585.244.9841.