insurance accepted and billing for pediatric care
Financial Responsibility Policy

Thank you for choosing The World of Pediatrics. Please, review the information listed below to help you better understand our Insurance and Billing Policies and Procedures.

The patient, their parent, or their guardian is personally and ultimately responsible for payment of all services provided by The World of Pediatrics.

Insurance

We will file insurance for those patients that are covered by private insurance or Medicaid plans that we accept, provided that proof of eligibility can be established on the date of service. It is the patient’s responsibility to know what type of insurance they have and the type of coverage it provides. It is their responsibility to know what their insurance covers. If we are not informed of any special requirements and services that are subsequently not covered, the patient is still personally responsible for their bill. Please, do not hesitate to contact us with any questions regarding your bill.

Participating Insurance Carriers - Updated May 2013

(Note: Not all plans are listed. Please, call to see if we accept any plans that are not listed below.)

Major Participating Carriers/Networks

NOTE: Medicaid, Amerigroup, Peachstate, HMO, and POS plans must have Dr. Lyudmila Vayman listed as the patient's Primary Care Physician (PCP) or the patient's insurance will not cover services rendered.

  • Aetna (all plans)
  • Blue Cross & Blue Shield (all plans)
  • Choice Care (Humana PPO)
  • Cigna (all plans)
  • Coresource
  • Coventry (HMO, PPO and POS)
  • Covenant Administrators
  • Definity
  • Empire
  • First Health (and any plans under this network)
  • FISERV
  • Fortis
  • Healthnet
  • Humana
  • Great West
  • Golden Rule
  • Guardian
  • Kaiser (MultiChoice Plan Only) Dr. Vayman is a tier 2 doctor on this plan
  • Multiplan (any plans under this network) (formerly: PPG -Preferred Plan of GA)
  • One Health Plan (includes Great West)
  • PHCS (and any plans under this network)
  • Principal Mutual
  • Promina
  • Southcare (and any plans under this network)
  • State Health/State Merit
  • Time Insurance
  • Unicare
  • United Healthcare (all plans)
  • USHC [Aetna US Healthcare] (all plans)
  • Georgia Medicaid [Georgia Health Partnership]
  • Peachstate
  • Amerigroup

Miscellaneous Participating Carriers/Networks:

NOTE: Medicaid, Amerigroup, Peachstate, HMO, and POS plans must have Dr. Lyudmila Vayman listed as the patient's Primary Care Physician (PCP) or the patient's insurance will not cover services rendered.

  • 1st Medical Network
  • Afra Health Fund
  • AIG Insurance
  • AmeriBen Solutions
  • American Postal Workers Union
  • Atlanta Plumbers & Steamfitters
  • Beech Street
  • Benesight
  • CCN (Community Care Network)
  • Century Healthcare
  • Core Administrative Services
  • Evolutions Healthcare Systems
  • Federated Insurance
  • General American
  • Gallagher Benefit Administration
  • GHI
  • Healthcare Inc. (formerly Prominia)
  • Healthsource
  • Healthstar (and any plans under this network)
  • Jefferson Pilot
  • John Alden Life
  • John Hancock Insurance
  • Mailhandlers Benefit Plan
  • Mutual of Omaha
  • Nova Net
  • NPPN (National Preferred Provider Network)
  • PHN (Preferred Health Network)
  • PPOG
  • Preferred Plan of G
  • Preferred One
  • Principal
  • Provident
  • Prudential
  • Reliastar
  • Screen Actors Guild
  • Trustmark
  • Tufts Health Plan
  • World Insurance
  • Writer's Guild

MEDICAID

Medicaid patients, their parents, or their guardians are responsible for ALL medical expenses in the event that the patient loses Medicaid coverage during the course of treatment.

We accept Straight Georgia Medicaid, Peachstate, and Amerigroup. WE DO NOT ACCEPT WELLCARE. PLEASE MAKE SURE THAT YOU ASK FOR YOUR CHILD TO BE PUT ON A MEDICAID PLAN THAT WE DO ACCEPT.

NOTE: Medicaid, Amerigroup, and Peachstate plans must have Dr. Lyudmila Vayman listed as the patient's Primary Care Physician (PCP) or the patient's insurance will not cover services rendered.

Proof Of Insurance

Patients must show their current insurance card at every visit. We need to verify that we have the correct insurance information, so that the patient does not receive a bill due to filing errors. We will attempt to validate the patient’s insurance eligibility for benefits at the time of service and alert them of any problems. If we cannot receive proof of their insurance coverage on the date of service, then their account will be changed to self-paid status and we will need payment in full at the end of their visit.

Co-Pays & Deductibles

Patients must pay their co-payment and deductibles at the time of the office visit. Our contracts with various insurance companies require us to collect co-pays at the time of service. We accept cash, debit cards, credit cards (DISCOVER, VISA, MasterCard), and checks as forms of payment.

Usually insurance companies require that we collect a copay/co-insurance from the patient each time that we provide services for them.

If the patient needs to return for the following reasons and others not listed:

  • to bring back lab work
  • for hearing and vision screening
  • for immunizations

on a day other than the day of their original visit, the patient will be required, by their insurance company, to pay their co-pay or co-insurance for the day of the original visit and for the day that the patient returns to the office.

If for whatever reason, the patient’s insurance company does not ask for an additional co-pay or co-insurance, we will credit the patient’s account when we receive a complete explanation of benefits from them.

Returned Checks

In the event a personal check is returned unpaid from the patient’s bank, their account will be charged a returned check fee of $25, and their account may be placed on a “cash only” basis for one year.

Late co-pays

If a co-pay is not paid at the time of visit, a service charge equivalent to your co-pay will be added to your account.

Insurance Benefits – The patient must know what their insurance benefits are.

The patient’s insurance policy is a contract between the patient and their insurance provider. Our practice cannot know or be held responsible for the intricacies of the various insurance policies. The patient is solely responsible for knowing what services are covered, what services are not covered, how often the services are covered, and what portion of the payment is their responsibility. The patient is responsible for any portion of services that their insurance carrier did not cover, or for which they have a deductible that has not been met.

  • The patient should be aware of where their insurance carrier wants them to go for any lab, radiology, and special outside service procedures. Some insurance policies do not cover in-house labs and screenings with well patient exams. These labs or screenings are optional to you, but ultimately the patient is responsible for payment if these services are rendered.

  • Please be aware that some, and perhaps all, of the services provided may be non-covered services, and/or not considered reasonable or necessary under the patient’s insurance plan. The patient will be responsible for payment of all services rendered, regardless of insurance payment.

  • If the patient’s insurance plan requires them to choose a primary care provider, they must contact their insurance company and select Dr. Lyudmila Vayman as their provider as soon as their medical records have been transferred and prior to making an appointment. We cannot schedule any appointments, write prescriptions, or give any referrals until we are able to verify insurance eligibility with Dr. Lyudmila Vayman listed as the primary care physician for the patient.

Newborn or Newly Adopted Child

New babies or newly adopted children are covered for the first 30 days by the mother’s policy, regardless of which parent will provide ongoing insurance coverage. The parents or guardian should contact their carrier as soon as possible to add the new child to their policy. Permanent coverage must be established before the automatic 30 day coverage period expires (meaning we must be able to establish proof of eligibility for the patient themselves after 30 days).

Multiple Insurance Plan Coverage

If the patient is covered by more than one insurance policy, be sure they know which is considered primary. We must submit claims to the appropriate carrier(s) in the correct order or claims may be denied.

Explanation of Benefits (EOB) Statements

Patients will receive EOB statements from their insurance carrier. Our practice receives a copy of the same statements that the patient receives. Any charges which the patient’s insurance carrier designates as “patient responsibility” will be billed to them directly from our office at the end of the month. Payments are due upon receipt of statements or will be expected at the time of next service, whichever is earlier.

Billing & Payment

All professional services are charged to the patient, their parent, or their guardian. Payment is expected in full at the time of service. After insurance payments have been received, all balances are due within 30 days or prior to the next visit, whichever is earlier, unless other arrangements have been made. The patient, their parent, or their guardian is ultimately responsible for all outstanding balances regardless of insurance coverage. Please, discuss any financial problems with our billing office at 770-442-5437.

Self Pay

Patients that are not covered by insurance or are covered by a plan in which we do not participate, must pay for each visit in full at the time services are rendered. We will supply the information and documentation necessary for the patient to file their own insurance claim.

This may include situations where we cannot determine active coverage with your insurance carrier. In such cases, we will collect payment at time of service and refund any amounts that are received from your carrier.

Participating Insurance Carrier

Our practice will file an insurance claim within five business days of the patient’s date of service. If there are any problems with this submission, we will notify the patient immediately and request their prompt assistance with any conditions under their control that may be causing a delay in processing. If their insurance carrier does not respond within 30 days, we will submit a second claim. If their insurance carrier does not respond to our secondary submission within 60 days from the date of service, we will send the patient a statement, and payment will become the patient’s sole responsibility. The patient will need to contact their insurance carrier if they think their insurance company is responsible for payment. We will expect payment from the patient or the insurance carrier within 30 days of receipt of their statement.

After the patient’s insurance company has remitted payment, if there is any co-insurance amount owed by the patient, payment is due within 30 days or prior to the next office visit, whichever is earlier.

Medicaid Insurance

Medicaid patients, their parents, or their guardians are responsible for ALL medical expenses in the event that the patient loses Medicaid coverage during the course of treatment.

We accept Straight Georgia Medicaid, Peachstate, and Amerigroup. WE DO NOT ACCEPT WELLCARE. PLEASE MAKE SURE THAT YOU ASK FOR YOUR CHILD TO BE PUT ON A MEDICAID PLAN THAT WE DO ACCEPT.

NOTE: Medicaid, Amerigroup, and Peachstate plans must have Dr. Lyudmila Vayman listed as the patient's Primary Care Physician (PCP) or the patient's insurance will not cover services rendered.

Non-Covered Services

Patients are solely responsible for payment of all services that their insurance carrier has classified as non-covered services.

Deductibles and Co-Insurance

Patients are solely responsible for payment of all deductibles and co-insurances that their insurance carrier has classified as patient responsibility.

Non-participating Insurance Carrier

Our practice will expect payment from the patient at time of service, and it will be the patient’s responsibility to submit any claims to their insurance company for direct reimbursement to themselves. We will supply the information and documentation necessary for the patient to file their own insurance claim.

Letters, Forms, Medical Records

Fees for these services are typically not covered by insurance policies and are the patient’s sole responsibility.

Telephone Consultations

Insurance policies typically do not cover telephone conferences with physicians to discuss problems or medical issues. Fees not covered for these services will be the patient’s sole responsibility.

Labs and Screenings

Insurance policies may or may not cover labs and screenings drawn or performed in the office. Fees not covered for these services will be the patient’s sole responsibility.

It is the patient’s responsibility to know what lab company that their insurance requires them to use and any special conditions that they require them to follow.

Statements - are due on receipt

If charges remain unpaid after 30 days, a second statement will be mailed with a notice requesting immediate payment. If charges still remain unpaid after 60 days, a final statement will be mailed with a letter informing the patient that they will be discharged after 30 days. All further services during the 30 days will be provided on a cash-only basis.

The World of Pediatrics reserves the right to send the patient’s account to a collection agency after all efforts to obtain payment have been exhausted. The patient is then responsible for any collection costs in addition to the outstanding balance due on the account. If the patient’s account is in collections, the practice will use its discretion as to providing the patient with further treatment or asking the patient to find another physician.

Forms of Payment Accepted

We accept cash, personal checks, debit cards, Discover, MasterCard, and Visa.

Returned Checks

A service charge of $25.00 will be due for each bounced check.

Assignment of Benefits

All insurance payments of medical benefits must be made directly to Dr. Lyudmila Vayman or The World of Pediatrics.

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3005 Royal Blvd. S., STE 110, Alpharetta, GA 30022
Office Hours Monday through Friday 9:00am - 7:00pm, Saturday for sick only 10:00am - 12:00pm
Call 770-442-5437 for an Appointment
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