Insurance

North Shore Pediatrics, PC accepts almost all insurance carriers, including Blue Cross-Blue Shield, Cigna, Tufts, Harvard Pilgrim, Aetna, United, Health Care Value Management, Private Health Care Systems, Teamsters, and MassHealth. Please feel free to ask if we accept your insurance if you do not see it listed here.

NSP accepts Assignment of Benefits and will bill your insurance carrier for you. You will be responsible to pay any Co-Payments required by your insurance carrier at the time of your visit. We also offer a discount for payment of services on the day of the visit. In addition to cash and checks, NSP also accepts Visa, MasterCard, Discover and American Express.

Any questions regarding insurance or billing can be referred to our Billing Hot-Line at 978-624-2896.

North Shore Pediatrics is a completely electronic practice with a fully integrated scheduling, billing and medical record system, allowing our providers to easily access your child's medical history in either office.

Appointments

Appointments for physical and non-emergent routine care can be booked as much as 6 months in advance.  To book an appointment of this type, please call our office in Danvers at 978-406-4234.

Appointments for Sick Visits and Emergencies can be booked on the day of service. Our telephone lines are open at 8:00 AM and the staff will be happy to arrange an appointment for your child to be seen as soon as possible. It is our goal to see all sick children on a same day basis. Our offices are also open for sick and emergency visits from 8:00 AM until 12:00 PM on Saturday and Sunday.

Calls for appointments and Sick Visits after hours will be referred to our answering service and a triage nurse. In emergency situations after hours, please utilize the 911 system or report to your nearest Emergency Room.

We request that you provide our office with 24 hours notice if you need to cancel an appointment. Appointments that are not cancelled 24 hours in advance and "No-Shows," may result in you being billed a fee for the visit.

Referrals

In order to expedite your care, NSP has set up a Referral Line and Coordinator to assist you.  You can reach our Referral Line at 78-777-3908.

Nurse Triage

Because we understand that you may have questions that do not need a visit, NSP has a nurse triage system where you can get advice from one of our experienced nurses. If you would like to speak to a triage nurse, please contact our office. Our nurses will let you know if they determine an appointment should be made with one of our providers.

The Story on Co-Payments

With the rising cost of health care and health care premiums, many insurance companies require that you pay a co-payment each time you visit the doctor's office. While each insurance plan differs in the way they administer their co-payment program, most require a co-payment be paid by the member no matter what the reason for your visit to the doctor.

Each physician's office enters into a contract with insurance companies that require that we collect co-payments from the patient. In many cases, our compliance with collecting co-payments is directly tied to our payment for services rendered. Most physicians' offices get audited by insurance companies to insure quality of care and compliance with the terms and conditions of the agreement between the office and insurance company. The penalties to the physician' office for non-compliance can range from financial penalties to discharge from the insurance company's provider network.

On January 1, 2007 North Shore Pediatrics enacted a policy that requires that all co-payments be made at the time of service and that failure to pay a co-payment at the time of service would result in a $20 service fee to the patient's account. Our decision to implement this policy was a difficult one. We do not want to increase the financial burden for health care on our patients. However, we must also be in compliance and be financially viable as well. Upon implementation of this policy, we saw an increase in the number of co-pays paid at the time of visit to almost 100%.

Because we understand that sometimes there are factors beyond any of our control, we also decided to waive one $20 fee per family. Please remember to bring your co-payment with you when you come to the office. We also are aware of health plans that do not require co-payments for some visits but do for others. We are happy to work with you and your health plan to determine when co-pay is due. Should you have any questions about co-payments, or insurance in general, you may contact Kristen or David; they will be happy to help you.

Patient Accounts

Medical Offices and hospitals are two of only a very few business that provider services to customers without requiring payment at the time of service. For example, you cannot go to the grocery store, dry cleaners or a restaurant and leave without paying for your purchases or the service you received.

In our business, we must rely on accurate health insurance information from parents to bill insurance carriers and often that is not enough to get a claim paid. We work very hard to make sure that each claim that should be paid by an insurance carrier is paid by that carrier. However, there are times when claims are not paid by insurance, such as when a deductible is involved, or it is a non-covered service. In those cases, the parents become responsible for the bill for services and should receive an Explanation of Benefits from their insurance carrier informing them about the insurance company’s decision.

Our office sends our monthly statements to each patient with a balance on their account. We greatly appreciate your timely attention to those statements. If a balance goes unpaid for more than 90 days, the account goes into collections. For us, this means that we will not provide prescriptions or routine care until the balance is paid. While this rarely happens, and we are happy to work out payment plans when needed, there are times when we are forced to take this action since, unlike a grocery store or dry cleaners; we cannot take back the services we provided.

If you have any questions about our Patient Accounts policies, please contact Kristen or David.