Co-pays, referrals, making a payment, or having a balance due.

Which insurance plans do you participate with?
Click here to view our participating health plans.

How do I get a referral to a specialist (if your insurance requires a referral)?
If you or your provider believe your child needs to see a specialist:
1) First speak with the physician, nurse practitioner or physicians assistant caring for your child to insure that you are going to the correct specialist.
2) Secondly, obtain the specialist's telephone number from a staff member in our office so you can call for an appointment.
3) Lastly, once you have the date of your appointment and the specific name of the doctor you will see, call our office with that information and we will issue the proper referral.
NOTE: Many referrals are done via the internet. Some referrals require pre-authorization by your insurance company. All referrals need to be done and approved by your insurance company prior to going to the appointment with the specialist.
We do not issue retroactive referrals. It is the patient's responsibility to know whether or not their insurance plan requires a referral in order to see a specialist.

Why at each visit, must I pay a co-pay (for people whose insurance has a co-pay)?
Rules about co-pays are established not by us but by your insurance company.  Those rules are part of the contract or agreement between you and your insurance company. If it is part of your insurance agreement, we are legally obligated to request and collect that co-pay at each visit. Different insurance policies have different rules about co-pays. For further questions about this it is best to contact your insurance representative directly. A telephone number for questions (customer service) can usually be found on your insurance card.
 
I have a balance due and cannot pay right now. What are my options?
Please contact our billing department as soon as possible to set up a payment arrangement that will fit into your budget. We can start with small weekly or monthly payments in order to start decreasing your balance. The physician owners of PPNP insist on regular monthly payments in order to avoid further collection action and to keep your account in good standing. Additional payments are welcomed at any time.

With my income, I cannot afford regular health insurance. Any suggestions?
Highmark Blue Shield offers several plans that are geared toward income levels. Also, by calling 1-800-KIDSMED, you could find out if you qualify for Blue Chip or PA ACCESS. Our office also offers a sliding fee scale program that would reduce office visits and physical exams according to income levels. Please contact our Billing department for further information.

Who should I contact with other billing questions or about my insurance?
Call our billing department Monday through Friday 9:00 am - 4:00 p.m. at 1-570-253-9240 or contact your insurance representative directly. A telephone number for questions (customer service) can usually be found on your insurance card.

Back to FAQ table of contents