Insurance & Policies

Insurances

If you are not sure if we accept your insurance plan, please call the office to confirm.

If necessary, please contact your insurance company and notify them of a primary care physician change in order to receive coverage.

Pediatric Consultants of Troy participates with these insurances:

  • Aetna
  • *Aetna Better Health (Medicaid)
  • Affordable Network
  • Beaumont Employee Health Plan
  • *Blue Care Network
  • *Blue Care Network Focus
  • Blue Choice POS
  • *Blue Cross Complete (Medicaid)
  • Blue Shield of Michigan PPO (Community Blue, Blue Preferred Plus, Traditional PPO, Messa PPO, FEP, Personal Choice PPO)
  • Capp Care
  • CNN Network
  • Chandler
  • Choice Net
  • Choice One
  • Cigna
  • Cofinity
  • Direct Care America
  • DMC Smart Health (pending)
  • *Harbor Health
  • *Harbor Health (Medicaid)
  • *Health Alliance Plan (including Alliance Health and Life, Preferred Health Plan)
  • *Health Alliance Plan Marketplace
  • *Humana HMOx
  • McLaren Health Plans
  • *McLaren Medicaid
  • Medicaid
  • *Meridian Marketplace (Choice)
  • *Meridian Medicaid
  • *Molina Marketplace
  • *Molina Medicaid
  • Multi-Plan
  • One Health Plan
  • PHCS
  • Primary Health Services
  • *Priority Health
  • ProAmerica
  • *Total Health Care Commercial
  • *Total Health Care Medicaid
  • Unicare
  • *United Health Care Community Plan (Medicaid)
  • United Health Care (including Choice Plus)
  • United Physicians Health Insurance

*Insurance must have the Primary Care Physician assigned to any physician in our practice in order to receive full coverage.

Policies

Cancellation

All appointments are confirmed with a courtesy phone call prior to the appointment day. We understand circumstances arise but ask for a courtesy phone call 24 hours in advance to cancel your child’s appointment. We are happy to reschedule your appointment. In the event that an appointment is not cancelled and no one shows up, we reserve the right to charge a $25.00 no show cancellation fee per child.

Referrals

We are happy to work with many Pediatric Specialists to provide specialty care for your children. Your insurance carrier may require you to obtain a referral before seeing a specialist. When one of our physicians requests that you to see a specialist we will provide you with a list of physician(s) we recommend in that specialty. It is your responsibility to call the physician you wish to see and book the appointment. Once the appointment is booked please notify our office by phone with the date of the appointment and the doctor you will be seeing. We then can process a referral for you. We require 3-5 business days to process non-emergent referrals. In the event an emergent referral is needed our referral staff will direct you in how to obtain the soonest appointment possible. If you have any questions, please contact our referral staff.

Payment

We accept cash, check and credit; Discover, Visa, MasterCard, and American Express.

If you have insurance coverage all co-pays, co-insurance and deductibles are due at the time of service.

If you have no insurance coverage payment is due in full at the time of service.

It is the patient’s responsibility to provide our office with the most accurate insurance policy information in order to correctly bill services provided.

Account statements will be sent for accounts that have outstanding billed balances to be paid. Once three statements have been posted and no response has been made your account is eligible to go into collections.

If you have any questions regarding your account, or need clarification please contact our Billing Department Monday- Friday, 8:00am-3:30 pm.

Transfer

We’re sad to see you leave but understand you need to go. If you are transferring out of the practice and/or moving and would like to obtain a copy of your children’s medical records a medical release form and a payment are both due. Due to HIPPA regulations a release form must be signed by a guardian (see Medical Release Form in Forms Tab) and sent to our office. You may call or mail in a payment and mail, fax, email, or drop off the medical release form.

Fees are as follows:

  • $10.00 child/chart onsite
  • $30.00 child/chart storage retrieval fee
  • $50.00 overnight storage retrieval