Insurance

Gabriel Pediatrics participates with most insurance plans.  Please bring your insurance card with you for every visit.  We do not participate with Medicaid directly, however we do participate in a few Medicaid sponsored plans.   If your insurance plan is not listed below, please contact Fran Ragonese, Billing Manager at 718.833.2300 ext. 3004 or franr@gabrielpediatrics.com.

We do our best to stay on top of each patients insurance policy, however it is your responsibility to notify us of any changes in your insurance to ensure that the claim is sent to the correct insurance plan and you are not held responsible for the charges.  On occasion we may ask you to become involved in assisting us with contacting your insurance company to resolve a claim.  Also, it is your responsibility to understand the specific coverage benefits and limitations your plan provides. 

Gabriel Pediatrics wants to help you understand your medical bill and provide some information regarding the different charges you may receive as a result of receiving health care services. Please refer to following glossary to help clarify insurance terminology:

·        Co-payments- Co-payments are a contractual agreement between the policy holder and their insurance company. The co-payment is part of the payment which is issued to your physicians. This payment is made at the time of your child’s appointment. Well visits are excluded from Co-payments unless otherwise instructed by your insurance carrier.

·        Deductibles- Deductibles are an out of pocket expense. The amount of the deductible is based on the policy holders contract with their employer and their insurance carrier. There are in-network deductibles and out of network deductibles. Secondary insurance carriers normally do not pay the primary insurance deductibles.

·        Coinsurance- Co-insurance is also an out of pocket expense. Co-insurance is based on the member’s contract with their insurance carrier.   Some insurance carriers pay at a percentage rate of 80/20, while others may pay at percentage rate of 70/30; the rate varies.  Depending on the percentage rate, your insurance will pay that percent, leaving the balance to the member.  Unlike deductibles, a secondary insurance carrier may make payment. If the secondary insurance does not cover then the policy holder would be responsible.

·        Non-Covered procedures- The policy holder receives the explanation of benefits (EOB’s) in the mail from their insurance carrier, they explain what procedures were performed on that date of service. These are procedures that your insurance company will not cover and pay. The EOB’s will determine what the policy holder is responsible for if the insurance does not cover procedures.

 Self-pay patients are responsible for all charges and should be paid at time of service. If this is not possible you must see the billing department to discuss a financial agreement.

Please understand that the bills you receive from Gabriel Pediatrics, PC are based on the contractual agreements you have with your carrier.