|3 Questions You Need to Ask About Your Health Insurance
Before you select a new or updated health insurance plan,
please review these top 3 questions you should ask.
Affordable Care Act (ACA) / Marketplace Plans
We receive many inquiries regarding the ACA and whether we accept any of the marketplace plans. It is up to the managed care companies if they choose to include us in the network for any plan, and we are not always notified or given specific plan names. Even if we are contracted with a major managed care company (e.g. United HealthCare, Humana, etc.) that does not mean we are included in all of their plans, including marketplace plans. Each company can have hundreds of plans, and each of those plans can have different provider networks included.
Our recommendation to patients is to check the participating providers listed for any plan you are considering. If our pediatricians are not listed, that means the plan has not included PHCA in their network.
Please Note: If PHCA is not listed on a plan you are considering, be aware that plan may have a narrow network that does not include a variety of providers and may not cover a full range of benefits and services.
Medicaid MMA Plans - Limited Availability
If you are selecting a Medicaid plan and would like to join our practice, please note that we only participate with Sunshine Health and Amerigroup. Our offices are limited on the number of patients we can accept on these plans, and there are times when some locations are not able to accept new patients. Our current status with each plan is listed below.
Also please note we do not accept AmBetter from Sunshine Health, which is a separate plan with its own provider network.
New Patients - As of December 5, 2017:
- Sunshine Health - All PHCA offices are accepting new patients.
- Amerigroup - Accepting new patients at Northside, Citrus Park, Brandon Community, North Carrollwood, FishHawk, Big Bend, Suncoast, Crossroads, and Walsingham.
Amerigroup - Established Patients:
- If your family has an established patient on Amerigroup, and you are pregnant or adopting, please contact your pediatrician's office regarding our sibling policy. Every effort will be made to accommodate siblings of established patients so you can stay at the same office.
- If your family has an established patient and you change your insurance to Amerigroup for any reason, you may stay with your current pediatrician. Please contact your pediatrician’s office to provide new insurance information.
Insurance and Billing Policy
- For every office visit, please bring your most recent insurance card to ensure the information is valid at the time of service. Incorrect or out-of-date information can delay your claim and you may be held responsible for full payment of the claim.
- Your insurance card is similar to a driver's license or credit card - the information must be valid in order for it to be used.
- The insurance companies do not supply us with claim forms or policy numbers. If your insurance company requires specific forms, it is your responsibility to provide them to our office.
- We must emphasize we cannot accept responsibility for collecting or negotiating insurance claims. We will gladly assist in completion of required additional forms and supplying additional information and/or patient records. As a reminder, billing a health insurance provider on your behalf is a courtesy we provide to our patients.
Please review our Billing Guidelines for more information.
At all Pediatric Health Care Alliance offices, payment is due at time of service and is collected at check-in. This includes co-pay, co-insurance, deductible, and/or any outstanding balance on the account. Payment may be made with cash, check, or major credit card.