Health insurance can be confusing and frustrating. In-network versus Out-of-network. PPO versus HMO. Co-Pay versus High Deductible Healthcare Plan. It is important to have a solid comprehension of your insurance plan and coverage.
Under The Affordable Care Act, insurance plans must provide coverage for preventative/wellness visits. Many times this includes regular well baby and well child visits, from birth to 21 years, and routine immunizations. This is why there is no cost to the parent when they bring their child in for their well child visits with in-network providers.
Coverage for sick visits will vary depending on your insurance payer and your specific plan. With the home calls for sick kids through Nebraska Home Pediatrics, we have seen the home visits covered three different ways.
The family has an insurance plan with a co-pay. When they take their child to an office for a sick visit the front desk collects the co-pay and the family owes nothing more after the office visit. This co-pay is the same when a Nebraska Home Pediatrics provider comes to the home for a house call. The family saves time and gas money when calling Nebraska Home Pediatrics for their sick visit needs plus the child or children are not exposed to additional illnesses at the office.
The family has an insurance plan that is a high-deductible healthcare plan. Usually this means that the families pays 100% out-of-pocket for all sick visits until their high deductible is met. When the family with a high-deductible healthcare plan use Nebraska Home Pediatrics for their sick visit needs and have a provider come to their home, the family will pay LESS than what they pay at the office because the fees with Nebraska Home Pediatrics is less than the fees at the office. Therefore not only does the family save money on the cost of the visit, but also they save time, gas money, and the child or children are not exposed to additional illnesses at the office.
The family has an insurance plan with a co-pay. When they take their child to an office for a sick visit the front desk collects the co-pay and the family owes nothing more after the office visit. Although this plan has a co-pay for an office visit, the plan does not view a house call as a co-pay visit and therefore passes the fee on to the family. Some families will still choose this option compared to going to the office because the parent knows that they are saving their time, gas money and that they are not exposing their child or children to additional illnesses and therefore possibly preventing additional sick visit needs.
Do you have an insurance plan that has co-pays for office visits and you are wondering if the plan would cover a house call from Nebraska Home Pediatrics the same as an office visit? Call your insurance company now and ask them how they process and cover CPT codes 99341-99350. If you have additional questions, please don’t hesitate to call Nebraska Home Pediatrics at (402) 917-6944. We are here to help and to keep your kids healthy!
Similar to your pediatrician’s office, Nebraska Home Pediatrics will bill your insurance company based on the level of service provided at the visit.
It is the patient or parent/guardian’s responsibility to understand their insurance coverage. Any questions specific to your insurance plan should be directed to your insurance payer.
**This list is not fully inclusive. Please call (402) 917-6944 or contact your insurance carrier to confirm network coverage.**
New rates coming soon. Please call (402) 917-6944 with questions.
Nebraska Home Pediatrics does their best to know which plans are out-of-network, but ultimately it is the responsibility of the parent or legal guardian to know if their insurance plan covers Nebraska Home Pediatrics as an in-network provider.
If you would like to verify your in-network coverage, contact your insurance company and ask if Nebraska Home Pediatrics is in-network. Your insurance company many ask you for some of the following information:
Business name: PedXM, PC doing business as Nebraska Home Pediatrics
Business address: 2953 S. 168th St., Suite 101, Omaha, NE 68130
NPI: 1043726524
Call them and ask if Nebraska Home Pediatrics is considered an in-network provider.
