Financial & Insurance

financial insuranceIt is our mission to provide you with affordable, high-quality treatment that fits your budget! We offer a variety of payment options to meet your needs. Our office accepts payments by cash, checks, and Visa, MasterCard, American Express and Discover credit cards. We also offer a discount for patients without insurance coverage. If you have any questions about payment, ask us! We will thoroughly explain your choices and work hard to accommodate your needs.

After Hours Appointments and Phone Services:

Our office hours are from 8:30am to 5pm. Appointments or phone services that occur after these hours may result in an extra charge to your insurance. This is a standard and nationally accepted procedure for a medical practice.

Insurance

We participate with, and are a preferred provider for, many insurance carriers. If your insurance covers medical treatment, you will receive the benefit of reduced personal costs. Insurance policies vary, so we will review your insurance to determine the appropriate course of action. Once treatment has started, we will file your claims.

To help us with your insurance filing, please complete the insurance questions on our questionnaire.

IMPORTANT CHANGE TO PAYMENT POLICY BEGINNING JANUARY 1ST 2017:

Thank you for choosing JPA as your child’s health care provider. As of January 1st, 2017, Jamestown Pediatrics will be changing our billing policy. According to many health insurance plans, it is your responsibility to pay any co-pay, deductible, co-insurance, and/or costs for uncovered services. For those families that have one of these plans, JPA will be charging a standard fee prior to seeing one of our providers for many types of visits as your out of pocket responsibility for payment . The standard fee will be $80.00 per visit that must be paid before you see one of our providers for any sick visit. There will continue to be NO fee for any of your child's preventative well checks and/or immunizations. This standard fee will include your current co-pay, the discounted rate for an appointment, as well as the average lab testing for sick issues during a visit. After charges for your visit are finalized, if the charged amount is less than $80.00 the balance will remain on your account as a positive balance to be used for future appointments. Any charges that exceed the $80.00 standard fee will be billed out to the patient and be the responsibility of the patient to pay according to current JPA billing policy. Any family account with a positive balance may be asked to make a payment before another appointment is scheduled. If your child is sick and you are unable to pay for an office visit our nurses and providers will always be available to offer you advice via telephone. 

Please remember that insurance is a benefit for you or your child. If, during the course of treatment, your benefits change, the financially responsible party is accountable for all charges.

Often times when patients come in for their annual routine visit, they also present with additional problems. While the appointment may have been scheduled as a routine physical, should a problem or chronic problem be addressed and treated and both services are performed during your visit, then both services may be billed. We are legally obligated to assign procedure codes based on the service provided to you, whether it is an “annual physical”, a visit to take care of problems, or both. This billing standard may create additional out-of-pocket expenses, such as copay or deductible, depending on your coverage. If you prefer to have your annual exam scheduled as strictly a preventative service, a separate follow-up visit for your other concerns will be scheduled and billed accordingly. 

Thank you for your cooperation as Jamestown Pediatric Associates strives to comply with national and insurance plan billing standards and provide quality care to our patients. Should you have any questions, please contact our billing department at 716-664-2589


Due to high volume of insurance companies, and their agreements with varying provider networks, we cannot be responsible for tracking the specifics of each patient’s benefits.

If your insurance company does not cover a particular lab or procedure that has been ordered, you will be responsible for payment of that service.

IF YOU HAVE ANY QUESTIONS ABOUT WHAT WILL BE COVERED, PLEASE CONTACT YOUR INSURANCE COMPANY.

DEDUCTIBLES, CO-PAYS, and CO-INSURANCE:  If you have an insurance that has a deductible, co-pay, or co-insurance, any amount not covered by insurance must be paid at the time of service. Co-Pays are due at the time of service. A $15 service charge may be applied if you are unable to pay at that time.

INSURANCES THAT REQUIRE PRIMARY CARE PHYSICIANS:  If you have an insurance company that requires a Primary Care Physician to be chosen, it is your responsibility to be sure that it is correctly listed.  We will not be able to see you at the scheduled time if the PCP is not correct.

JPA is committed to maintaining the accuracy of every claim it processes and submits. Billing for Medicaid eligible patients will be done in compliance with all applicable state and federal laws and regulations. JPA promotes full compliance with each of the relevant laws by maintaining a strict policy of ethics, integrity, and accuracy in all its financial dealings. Each employee and professional, including outside consultants, who is involved in submitting charges, preparing claims, billing, and documenting services is expected to maintain the highest standards of personal, professional, and institutional responsibility. 

IT IS YOUR RESPONSIBILITY TO UNDERSTAND WHAT YOUR INSURANCE DOES AND DOES NOT COVER:

 

Often when the patient is scheduled for an annual well child visit or physical, they also present with additional problems. An annual exam visit does not include the discussion of new problems or detailed review of and/or management of chronic conditions. We are legally obligated by your insurance carrier to assign procedure codes based on the services provided to you, whether it is an annual physical or a sick visit, or both. This billing standard may create additional out-of-pocket expenses, such as co-pay or deductibles, depending on your coverage, and you will be held responsible for any charges that your insurance does not fully cover.