Insurance & Billing Information
Call Medical Management Services at (512) 692-4915 for questions related to your bill.
Private pay patient charges must be paid in full at the time of visit. We offer a 20% discount on all of our services for patients without insurance, which is comparable to the typical insurance company contracted payment discount.
As a courtesy to our patients we have enrolled in many managed care programs. By doing this, we agree to file your insurance
claims and accept the contracted rates from your insurance company. However, we do not take responsibility for items not covered in your
individual plan. Therefore, we recommend that you always question your insurance company regarding your benefits and do not assume that everything done in the physician’s office is covered by your insurance. You can request specific benefit information from your insurance company before attending your appointment.
Prior to any office visit, please be sure that you have contacted your insurance company to add your new baby or child to the insurance policy. If you have an HMO plan, it will also be necessary to designate our doctors as the PCP prior to the appointment. If any claim
is denied, you will be responsible for the payment.
It is important that you understand what coverage is available for your child. Ask your insurance company for specific information regarding well child, immunization and sick child visits, as well as co-payment and deductible costs.
Please bring your insurance card to every office visit. We will ask for a copy of this card when you check in for your child’s appointment.
Insurance Company Policies
Insurance company contracts require us to collect your copay at the time of service. We feel it is the easiest to collect this at the beginning of the visit so when your appointment is over, you are free to leave unless you need further assistance.
Since insurance companies access the copay we are not allowed to adjust or waive a copay for any visit.
Filling Insurance Claims
We submit the charges for your child’s appointment to your insurance company the same day your child is seen by our clinic.
Claims are submitted to the insurance company for payment as required by your contracted benefits. HIPAA privacy laws do not allow us to know the patient’s specific insurance benefits. When we call to verify your coverage, we are told at the end of every call that ”THIS IS NOT A GUARENTEE OF BENEFITS”, so it is very important for you to understand your coverage prior to your appointment so that you will not receive an unexpected bill for clinic charges not covered by your policy.
As per our contract with your insurance company, we are paid an amount that is predetermined for each service your child received, which is a discounted rate for our services. Insurance companies do not tell us what service codes or charges that will apply to your deductible.
When we receive the EOB (Explanation of Benefits) from your insurance company, we will post the payment according to the insurance contract. Your insurance company will also send you an EOB that will list any balance that may be due to our clinic.
Contact your insurance company immediately after your baby is born. It is important that the baby’s name be added to the policy prior to your first appointment and within the first 31 days of life. Many insurance companies will deny claims if this is not completed. If your plan is an HMO or requires a selection of a PCP, please specify that our physicians are designated.
United Aetna BCBS Humana Cigna
Great West Scott & White Health Plan
Tri Care and other major insurance
Round Rock Medical Center
North Austin Medical Center
Children’s Hospital of Austin