Your insurance policy is a contract between you and your insurance company. While we will submit claims on your behalf and assist with the process, please understand that you are ultimately responsible for knowing your benefits, coverage limitations, and financial obligations.

We recommend contacting your insurance provider directly to verify coverage for services before appointments. Our office staff can help answer general questions, but your insurance company is the definitive source for information about your specific plan’s coverage.

If your insurance denies payment for any services rendered, or if there are unexpected coverage issues, you will be responsible for the balance. We’re committed to providing transparent communication about costs, but the final determination of benefits comes from your insurance provider.

 If you don’t have insurance, we offer self-pay options for every service we provide.

PREPARING FOR YOUR APPOINTMENT: WHAT TO KNOW BEFORE YOU ARRIVE

• Ensure we have accurate and up-to-date insurance information, and notify us promptly of any changes.
• Add your newborn or adopted child to your insurance plan as soon as possible—no later than 30 days after birth or adoption—by informing your employer.
• Contact your insurance company to confirm that your provider is covered under your plan.
• Familiarize yourself with the healthcare benefits your insurance plan provides.
• For new patients – completion of the New Patient Forms

CHECKING IN FOR YOUR APPOINTMENT: WHAT TO EXPECT

• Present your insurance card and ID upon request
• Pay your copay, if applicable.
• Settle any outstanding balance on your account.

If your service is not covered by insurance or you do not have insurance, be prepared to pay the self-pay fee.

Navigating your health insurance policy can be overwhelming. We are here to assist you in understanding how your coverage works for our services.

DEFINITIONS

Allowed Amount – The amount your insurance company deems reasonable and customary for the service provided.

Benefit Level – The highest amount your insurance plan will pay for a covered benefit.

Benefit Year – A 12-month period during which your insurance benefits are valid, which may or may not align with the calendar year.

Claim – A request submitted by our office for your insurance to cover medical services you received.

Coinsurance – The portion of the cost for covered services that you are responsible for after meeting your deductible, usually expressed as a percentage (e.g., if insurance covers 80%, you pay 20%).

Coordination of Benefits – A process used when you have two health insurance plans to ensure that neither pays for the same service. This typically requires the policyholder to complete a form or make a call to the insurance company at the start of the year.

Copayment – A fixed amount you pay for certain medical services, such as a $25 fee for each doctor’s visit, typically collected at check-in.

Covered Benefit – A service that your insurance plan includes as part of its coverage.

Deductible – The amount you must pay annually toward your medical expenses before your insurance company begins contributing.

Dependent – A person (such as a spouse or child) who is covered under the primary insured member’s health insurance plan.

Explanation of Benefits (EOB) – A detailed statement from your insurance company explaining how a medical claim was processed and paid.

Insurance Company – The organization that administers your healthcare benefits and makes payments for services provided.

Insurance Plan – A specific coverage plan offered by your insurance company, with distinct benefits, terms, and coverage levels, typically chosen by your employer.

Out-of-Pocket Maximum – The total amount you’ll pay for medical expenses in a benefit year, which includes deductibles, copayments, and coinsurance, excluding premiums.

Patient Responsibility – The amount you owe after your insurance has paid its portion, which we will bill you for based on the details from your insurance plan.

Sick Visit – An appointment for non-preventive care, including acute illnesses like flu, sore throat, or chronic condition management such as ADHD or asthma; typically requires a copay or coinsurance.

Well Visit – A visit for routine well-child care, typically including several visits during the first year of life and annually after, often without a copay for covered plans.

CHECKING OUT AFTER YOUR APPOINTMENT

• Schedule your follow up appointment (if ordered)
• Schedule your next well visit
• If you do not have insurance, please pay for any additional services received during the visit.

SELF PAY SERVICES

We offer self-pay fees for the following situations:

• Patients without insurance
• Services not covered by insurance
• Patients with high-deductible plans who prefer to pay out of pocket instead of using insurance
• Payment for self-pay services is collected at the time of check-in.

Self Pay Price List  (must be paid at time of service by cash or credit)

New patients : $100

Established patients – $75 

Vaccines : Vaccine Administration fee of $24 per vaccine + Cost of Vaccine (Varies)

OUR INSURANCE PARTNERSHIPS

Aetna Better Health

Aetna (most plans)

Amerihealth

Cigna (most plans)

Fidelis Care

Horizon Blue Cross / Blue Shield (most plans)

Horizon NJ Health

Magna Care

Medicaid

Meritain Health

Oscar

Oxford Health

United Health Care

United Health Care Community Plan

Wellpoint