7/2/2024

Please view the full financial policy here.

ACCEPTED INSURANCES

By contracting with these companies, Raleigh Pediatric Associates has agreed to file insurance for patients who participate in these plans*. In order to do so, we must see your child’s insurance card at each visit and if you participate in a managed care program, one of our physicians’ names must appear on the card. If you do not have the necessary information and we are unable to verify your coverage, we must ask for payment at the time of the visit.

*NOTE: Participating and contracting are two different things.  Your employer/insurance group may have Raleigh Pediatric physicians as participating with their plan.  HOWEVER, Raleigh Pediatric Associates only files and accepts insurance payment from companies with which we have a SIGNED CONTRACT. These companies are listed below. Please always check with us if you are unsure.

We collect all co-payments at the time services are rendered and file insurance on a daily basis. A monthly statement will be sent to you detailing unpaid charges. If you have questions regarding items that have not been paid by your insurance, we ask that you contact your insurance company or employer as benefits packages vary by employer.

SELF-PAY — If you have insurance with which Raleigh Pediatric Associates does NOT contract, your account will be considered self-pay. You must pay in full at the time of service and file your own insurance. No insurance adjustments will be made to these accounts.

ACA EXCHANGE PLANS

Raleigh Pediatric Associates participates with the following ACA Exchange Plans:

• AETNA NC Connected Care Plan
• BCBS All Copay Plan
• CIGNA CONNECT
• UHC COMPASS
• UHC Advantage, Value, Saver and Essential
  • Gold, Silver, Bronze and Platinum

CONTRACTED INSURANCES

• Aetna
  • Including:
    • Aetna First Health – card will have First Health heart logo on it
    • NC State Employees Health Plan – Please note effective 1/1/2025 we will NO LONGER be participating in the Clear Pricing Project (CPP)
  • Exception: RPA does not participate with Aetna Indemnity plans
• Blue Cross & Blue Shield of North Carolina
  • Including:
    • BCBS Federal Employees Health Plan
  • Exception: Raleigh Pediatrics does NOT participate in the BCBS High Performance Network
• Cigna Healthcare
  • Exception: Raleigh Pediatrics does NOT participate with Cigna Indemnity plans.
• MedCost PPO
• United Healthcare
• WakeMed Employee Plan via Contigo Health
• Medicaid
  • RPA only accepts patients who meet the following qualifications
    • New patients FOUR (4) months of age and younger
    • *Established patients and **their siblings
  • Medicaid Plans
    • NC Medicaid Direct
    • WellCare Medicaid
    • United Healthcare Community Plan Medicaid
    • Alliance Tailored Plan

*A patient is considered established only if they have been seen by one of our physicians in the last 3 years and have not transferred out of the practice.

**Siblings include adopted, foster and legal guardianship

The physicians of Raleigh Pediatric Associates perform comprehensive well exams on their patients following the Bright Futures (American Academy of Pediatrics) recommendations. These recommendations include timing of the exams along with appropriate testing, screening and lab work. It is possible that some portion of the exam may not be covered or may be applied to a deductible by your insurance company and then would be your responsibility. While we are sensitive to costs, we believe all of these screenings are necessary to provide the best care for your children.

Examples of routine screening tools used at well visits include

• General Screenings: Vision, Hearing, TB screen, Lead Screen
• Developmental Screening Tools
  • M-Chat: Autism screening tool (routinely done at 18 months and 2 years)
  • PEDS Response: Parent Evaluation of Development Status (at intervals between 6 months – 5 years)
• Behavioral and Psychosocial Screening Tools
  • EPDS: Edinburgh Postpartum Depression Screening (routinely done at 1 month, 2 months, 4 months and 6 months well exam)
  • RAAPS: Rapid Adolescent Assessment for Preventative Services done annually 11 years through 22 years

Special Charges

Please see the full financial policy for additional details.

• After Hours – there is an additional charge for visits outside of regular hours (Monday-Friday, 8-5) including designated holidays and Saturdays or Sundays.  Please see the full financial policy for additional details.
• Office Visits with a Physical – if during a well child visit, additional issues outside of normal physical guidelines are addressed, an office visit may be charged in addition to the physical.
• Outside Lab Charges – when lab work is sent to an outside laboratory, you will receive a separate bill/statement from that lab.  Please be sure to inform the staff if your insurance requires lab work be sent to a specific vendor.