Insurance and Billing

Updated: 12/23/2025 

2026 CONTRACTED INSURANCE PLANS

Raleigh Pediatrics understands that in addition to feeling comfortable with your child’s physician, many parents have questions about the financial policies of the practice. These are items you must be aware of prior to your child’s visit:

• If your child is a member with one of our contracted insurance plans, please have your insurance card or other insurance verification with you at the time of your visit. Failure to have proof of insurance coverage for your child may mean the charges are due at time of service.
• CO-PAYS ARE DUE AT THE TIME OF SERVICE
• If we are not a CONTRACTED provider for your insurance, you are not insured or we do not file with your insurance company, you WILL be responsible for the entire charge at the time of the service.*
  • *A discount of 15% will be given to any Self-Pay patient that pays at time of service AND is not contracted with one of our insurance carriers.
• It is imperative that you know your children’s eligibility status as well as their covered benefits. Although we are happy to supply you with an estimate of your child’s visit, it is a good idea to check with your insurance or employer as to what your family’s covered services are and your potential responsibility.
• We do not currently participate with ANY indemnity plans including those associated with contracted insurance.

ACA EXCHANGE PLANS

Including: Blue Cross/Blue Shield / Cigna / United Healthcare

Exception: Any other ACAs including Ambetter

AETNA PPO/MC

Including: NC State Employees Health Plan

BLUE CROSS & BLUE SHIELD of NC

Including: BCBS Federal Employees Health Plan

Exception: No Out of State plans UNLESS the card has ‘PPO in box’ logo

CIGNA HEALTHCARE

MEDCOST PPO  

UNITED HEALTHCARE 

WAKE MED EMPLOYEEs

                2026 BCBS administered by Brighton Health Plan Solutions

MEDICAID-only the following products

NC Medicaid Direct / PHP-WellCare Medicaid / PHP-UHC Community Plan Medicaid

Tailored Plan-Alliance / Healthy Blue Care Together BUT only for members of the Children & Family Specialty Plan

**RPA ONLY ACCEPTS MEDICAID PATIENTS WHO MEET THE FOLLOWING:        

1-New patients FOUR months of age and younger

2-Established patients and their siblings

• • • 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

RALEIGH PEDIATRIC ASSOCIATES 2026 FINANCIAL POLICY

It is extremely important for you to understand the financial policies that will affect your family. Please take time to review and contact our Accounts Receivable Department at 919-872-0250 for questions or clarification.

MOST IMPORTANT—It is imperative that you know your children’s eligibility status as well as their covered benefits. Although we are happy to supply you with an estimate of your child’s visit, it is a good idea to check with your insurance or employer as to what your family’s covered services and your potential responsibility.

CONTRACTED INSURANCE

• Raleigh Pediatrics will file insurance ONLY for plans with which we are contracted. See listing.
• All copays are due AT THE TIME OF SERVICE.
• Any deductibles, co-insurance or other amounts deemed patient responsibility are DUE IMMEDIATELY.
• You must bring your current insurance card/proof of eligibility with you AT EACH VISIT.
• It is your responsibility to keep us updated with your correct and current insurance information.
• If we are unable to file within the time limits of your insurance based on lack of correct information, you will be held responsible for charges.

CONTRACTED VERSUS PARTICIPATING INSURANCE

• Raleigh Pediatrics has many CONTRACTED insurance plans as mentioned on our Insurance Plan page. These are companies with which Raleigh Pediatric Associates have signed contracts for fee schedules, certified contracted physicians, and coding requirements.
• Sometimes this is confused with PARTICIPATING or IN-NETWORK insurance providers.  Any insurance group can choose a physician to be ‘participating’ or in their insurance ‘network’. HOWEVER, Raleigh Pediatrics will only file and accept payment from our contracted providers.
• If your employer or broker tells you that Raleigh Pediatric physicians participate with their insurance, it is best to check with us to make certain we will be filing your insurance and accepting their fees.
• If not, your children are still welcome to see our physicians, but you will be considered Self-Pay. You will be responsible to pay at the time of visit and file insurance yourself.  We are happy to give you an itemized and coded statement to assist you in that.

SELF PAY PATIENTS

• All patients who carry non-contracted insurance plans or have no insurance are considered Self Pay.
• Payment IN FULL is due when services are rendered. Continued non-compliance with payment in full at checkout may result in termination of care.
• A 15% discount for current services will be given IF you pay when seen. However, this is only if payment for today’s services is paid at time of check out.
• We will provide you with an itemized statement suitable for filing your own insurance at visit.

‘GOOD FAITH’ ESTIMATES

• You may contact our office for an estimate of your visit cost giving us at least 24 hours’ notice, when possible. This may be done via KLARA or by phone.
• This is ONLY AN ESTIMATE. Actual amount may be more or less depending on the physicians’ findings and recommendations.
• Families may want to check with their insurance or employer regarding coverage, deductibles, co-insurance and items that may not be covered by insurance.

BALANCES

• Patient balances are due at time of service or upon receipt of your insurance plan’s explanation of benefits.
• If you have questions/discrepancies as to the insurance company’s processing of a claim, you should contact your insurance company or employer. Coverage issues are between you and the insurance/employer.
• In rare cases we will contact your insurance IF you have been led to believe there was an error on our part. We will need the phone number you called, a reference number for the call along with the name of the insurance representative you spoke to.
• We are happy to help our families when the need exists but there are requirements that must be met to place a payment on hold. Continued non-compliance may result in termination of care.

NEW VS ESTABLISHED PATIENTS

• A patient is considered established only if they have been seen by one of our physicians in the last three years and have not transferred out of the practice.
• All others will be considered NEW in terms of coding choice as the medical staff will need to update records for the past three years

SPECIAL CHARGES

1. Office Visit with a Physical- If during a physical, additional issues come up outside of normal physical guidelines, an office visit may be charged in addition to the physical.
2. After Hours- There is an additional charge for visits after our regularly scheduled appointments. These most likely would be requests for care after 5:00 pm Monday-Friday; for Saturday and Sunday visits and for visits on office holidays when we have limited staffing. (Good Friday, Memorial Day, 4th of July, Labor Day, Friday after Thanksgiving).
3. Outside Lab charges- If lab work needs to be sent to an outside laboratory, you will receive a separate bill from that lab. Make certain you apprise our medical staff IF your insurance requires that lab work be sent to a specific vendor.
4. G2211–Recognizes the ongoing relationship between patient and physician and the extra time and effort it takes to manage the unique complexities of a patient’s need for the long-term through conversations, comprehensive care plans and collaborative decision making.

 SEPARATED/DIVORCED SITUATIONS – A copy of this policy in its entirety is available upon request.

In these situations, and because our patients are children, Raleigh Pediatric Associates rely on parents and other supportive adults to assist us in their care. Custody issues and healthcare payment responsibility present our practice with unique challenges. We have a policy and agreement for families that establish Raleigh Pediatrics’ guidelines and expectations in terms of parents’ communication with one another to help us avoid any misunderstandings going forward.

PLEASE LET OUR STAFF KNOW IF YOUR FAMILY HAS A SEPARATED OR DIVORCED SITUATION SO THAT OUR POLICY CAN BE GIVEN AND EXPLAINED TO YOU.

Routine Screening Tools

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