How do I find out about my benefits? 

It is your responsibility to know your health insurance plan. Here are 3 ways to do it:

1. Review your plan benefits with your insurance agent
2. If your plan comes from your job, you can review benefits with your Human Resource Department
3. Call Customer Service at your insurance company. The phone number is usually on the back of your insurance card.

I don’t really know my insurance benefits. Can you tell me what they are?

Unfortunately, there are SO many health plans that we are not able to know them all. We do verify that insurance plans are active and what the status of your deductible may be, but we do not always know the exact benefits of your plan.

How will I know how much you are going to charge me?

For every visit, your insurances company mails an Explanation of Benefits (EOB) to you. This document shows how much your insurance paid and what you need to pay based on the benefits and the deductible of your policy. This office receives the same information that you do along with the payment from your insurance company. We apply the payment and make any discount or adjustment per our contract with your insurance company. The balance on your account for that visit will then match the patient responsibility on your EOB. This is the amount that will be the amount that you are expected to pay to Pathway Pediatrics.

What is a deductible?

This is an amount of money that you must pay out of pocket every year before your insurance begins to pay. There are different deductibles for office services and hospital services. In the past few years, deductibles have been getting larger and larger. 

What is a co-payment?

This is an amount of money that you must pay at the time of the visit.  Copayment amounts vary per plan.  Your copayment amount is determined by your insurance plan.

What is a co-insurance?

Percentage of the visit that the patient is responsible for.  For example, some insurances are 20/80, meaning the patient is responsible for paying for 20% of the visit and the insurance company is responsible for paying 80% of the visit. 

What if I have a really large bill?

We are always happy to set up a payment plan. With our system, your card can automatically be charged each month. Contact our billing staff to discuss a payment plan. 256-208-0060 Option 4.

What if I need to dispute my bill?

If you ever have a concern about your account, please call one of our experienced billers or your insurance company.

What if I have 2 insurance plans?

Each plan may have different policy benefits and deductibles.   Often with 2 insurance plans, it is likely that they both will not cover all your services. Remember, it is your responsibility to be familiar with your plans and coverage.  If you have provided updated and accurate insurance information to our office, we will appropriately bill to both before notifying you if there is any remaining patient responsible balance.

Questions: To leave a message for one of our Billing Specialists, Monday through Friday from 8:00am to 4:00 pm at 256-208-0060 (Option 4).  You can expect to receive a call within 1 business day.