Copayments and Active Insurance Cards
Please prepare to pay your insurance co-pay at check-in at the time of service. It is important that we have up-to-date insurance information on your family’s health plan at every visit. It is your responsibility to notify us of any insurance changes. Many insurance companies have a timely filing period, or time limit for submitting a claim. Newtown Center Pediatrics cannot bill an insurance company if information is provided after this window.
We will submit a claim to all primary and secondary insurances. Once your insurance company has processed your claim, we will bill you for the remaining balance that you are responsible for, as determined by your insurance plan, such as deductibles and co-insurances. Payments are expected upon receipt of your statement. We accept Checks, Visa, MasterCard, Discover, American Express, and Apple Pay. If you have any questions about your statement details and insurance information, please contact Cindy at 203-426-3267.
Uninsured and Payment Plans
We recognize the financial burden that medical bills may cause, so please let us know if you are having difficulties paying your bill. If you are uninsured, self pay, please call us regarding payment plans to avoid misunderstandings.
Dr. Nowacki must follow accepted national guidelines when determining what your charges (level of service) will be. She must code your visit based upon what services were provided and cannot take into account particular health plan benefit designs. Consequently we are unable to switch the visit reason and diagnosis in order for a claim to be covered by your insurance. If you think there is an error on your account, please contact Cindy. She will review your concern with Dr. Nowacki and let you know the outcome. If an error was made, she will be happy to resubmit your claim as long as it is within your insurance company's filing limit (usually 60-90 days.)
You should contact your insurance company as soon as possible after your child has been born. Most health plans allow 30 days to add your newborn to your insurance plan. If your insurance plan requires you to designate a primary care physician (“PCP”), you must select Dr. Nowacki prior to your first visit. If Dr. Nowacki is not designated as the PCP prior to the first visit, you may incur extra costs if the insurance company processes the claim as an out-of-network visit.
Our goal is to accommodate all of our patients’ healthcare needs. Missed appointments are detrimental to us and to our patients who could have been seen during the time set aside for your child’s appointment. If you are unable to keep your appointment, please call at least 24 hours in advance to cancel. A "no show" fee of $50.00 will be applied to any missed appointments. Patient visits at Newtown Center Pediatrics are made by appointment only. Every sibling will need to have an appointment in order to be seen by our providers.
Insurance Plans and Coverage
Newtown Center Pediatrics contracts with many insurance plans in Connecticut to provide health care services to our patients. Please note, participation with these plans is not a guarantee of payment or coverage. We recommend that you familiarize yourself with your insurance benefits. Many insurance plans require a referral or prior-authorization for coverage of certain services. It is important to check with your insurance plan to ensure your specific benefits include coverage for services at Newtown Center Pediatrics. If you have questions regarding your benefits and coverage, please contact your insurance plan directly. Newtown Center Pediatrics accepts most major insurance plans in Connecticut including Aetna, Anthem Blue Cross Blue Shield, Cigna, Connecticare, Connecticut Medicaid (Husky), Oxford, Tricare Standard and United Healthcare.
Health sharing programs are not an insurance. Most health sharing plans are affiliated with different religious denominations with voluntary sharing among members for eligible medical expenses. We will bill your health share plan directly, as a courtesy; however, if the health share plan informs us of lack of funding or delays payment beyond 45 days, the account balance will become your financial responsibility until the account is resolved.
Annual Wellness Exams
Some insurance companies pay for one well child visit per calendar year. Other insurance companies have more stringent rules and say that at least 365 days must pass between well exams. If not, the second well visit will be denied by your insurance company, and you will be responsible for the charge. Be sure you understand your insurance company's definition of "annual" before scheduling the annual wellness appointments.
**All services that occur during a well visit are separately reportable (e.g., screenings, labs, vaccines). Disputes about cost-share (coinsurance/deductibles/copays) must be directed to your insurance plan. On occasion, our providers may also treat a new or existing medical problem during a well-child visit. Problems addressed during preventive visits are outside the scope of routine well-child care and are separately reported to your insurance carrier. In the event this occurs, you will be responsible for any additional copays, coinsurance,
deductibles, or other balances after the visit.**
We understand the difficulties involved in divorce and court orders. Newtown Center Pediatrics does not become involved in negotiating between parents/guardians in financial disputes. It is the responsibility of the parent attending the appointment to collect from the other parent.
We use Quest Diagnostics (or LabCorp if specifically requested). Please check with your insurance to make sure Quest is your contracted laboratory. You will be billed by Quest directly. Not all medically necessary services ordered by our provider are covered by every insurance plan. Please contact your insurance carrier directly for information about its coverage policies. Any service ordered by our provider and not covered by insurance will be the responsibility of the parents.
Coordination of Benefits (COB)
If both parents have their own commercial health coverage and each plan covers the same dependent child, the birthday rule is used to determine which insurance plan is primary and which is secondary. The rule states that for those families in which both parents have commercial health coverage, the parent whose birth month and birth day of the month comes first has primary coverage. The birth year is not taken into consideration. If your insurance company requests additional information from you, such as evidence of coordination of benefits, they will not reimburse our office until you provide that information. Failure to provide this information may result in full charges that will be deemed your responsibility.
How to pay your bill
Call our friendly front office team at 203-426-3267 to make a payment over the phone. Or mail a check to 10 Queen Street. Newtown, CT 06470. Please be sure to include your statement number and your child's name. In addition, we can keep a secure copy of your credit card on file for auto-payments, as requested.
Newtown Center Pediatrics is closely affiliated with Pediatrics at Danbury Hospital. Our newborns are cared for daily by the in-house neonatal team until hospital discharge.
While Dr. Nowacki maintains full admitting privileges at Danbury Hospital, there is a pediatric hospitalist on-call 24/7 to oversee most hospital admissions. For more serious
hospitalizations, or those requiring inpatient sub-specialty care, patients may be sent to one of our CT/NY Children's Hospitals including Connecticut Children's Medical Center, Yale, New York Medical Center and Boston Children's Hospital.
Connecticut Children’s Specialty Care Center – Danbury provides specialty clinics at their local satellite on 105A Newtown Road in Danbury, as well as at their Hartford location. Their local satellite clinics include cardiology, endocrinology, gastroenterology, hematology-oncology, nephrology, neurology, pulmonology, rheumatology and pediatric imaging. If you would like to schedule an appointment, please call our office so we can send a referral.
Yale New Haven Children's Hospital provides sub-specialty care in New Haven area. If you would like to schedule an appointment, please call our office so we can send a referral.