Pediatrician Lexington, KY

Our friendly, knowledgeable staff works hard to make your visits to our office as smooth as possible. We’ve provided helpful information about our office on this page, including directions, hours, insurance and billing, payment options and financing.

Appointments

Regular office visits are always by appointment. Please follow these recommended guidelines when scheduling an appointment with PAA.

• We prefer that you see several of our physicians, but you may request a particular physician if desired.
• We answer phone calls between 7:30AM and 5:00PM. If your child is sick, please call as early as possible.
• Weekends & After Hours Appointments - There may be an additional charge for weekend appointments and appointments after 5:00PM. Many insurance companies will pay this charge, however, some may not. In those cases, you will be responsible for the additional fee.
• If your child has a sudden, severe illness or accident, please call before coming to the office. We can see many emergencies in our office, but we may request that you go to the Emergency Room if deemed necessary.
• In order to assist us in remaining on schedule, please be on time. There are occasional emergencies and other factors that may delay your visit.
• Please call 6-8 weeks in advance for checkup appointments including sports physicals and camp physicals. Checkup appointments are not given after 3:30PM, because these appointments are reserved for sick children.
• Appointments for nursing visits for immunizations are given Tuesdays - Fridays from 2:00PM - 4:30PM.
• With the exception of formula for infants, please do not bring food or drinks into the office.
• Drop-ins & Siblings - We do not routinely see patients without an appointment. Please schedule an appointment for all children who need to be seen. If a sibling is also sick, an appointment needs to be made so that the physician can allot time to care for each child’s needs.
• No Shows/Tardiness - For the convenience of other patients, please try to be on time for your appointment. We also request a 24 hour notice to cancel appointments. Please be courteous of others. Your canceled appointment could be used by someone else. Frequent no-shows may result in dismissal from the practice.

Fees and Collection

• We are committed to providing excellent medical care at a fair and reasonable price. You are welcome to know any fee in advance and discuss any financial problems with our business office. Please do not be embarrassed to do so.
• Our office staff will be happy to discuss fees in advance or at the time of your office visit. We are understanding and try to accommodate unusual circumstances, such as prolonged illness, unemployment, or other unanticipated financial problems.
• There is a $25 charge for any checks returned.
• We feel that our requirements for keeping your account in good standing are quite reasonable. If, for some reason, your account is turned over to collection agency for non-payment, then you will receive a termination notice from our office. If services are terminated, then you will not be allowed to return to PAA.

Newborn Charges
Having a baby can be a very hectic time. However, it is very important to remember to add your baby to your insurance policy within 30 days of birth. This is required by all insurance companies. If you don’t add your baby within 30 days, then you could be responsible for all of your baby’s hospital and physician charges. Also, there are some insurance companies that do not pay for the pediatrician’s care of the baby while in the hospital. You should be aware of your insurance coverage policies.

Insurance and Billing

Insurance Cards
We must have a current copy of your insurance card and patient information. We may ask for a copy of this card at each visit. It is important that we are billing the correct company.

If your insurance changes, you must provide us a copy of your new card as soon as possible. We also must know when the new insurance becomes effective.

If you do not provide us with the correct insurance information, then you will be responsible for payment of the entire balance.

On occasion, we will ask you to complete a patient information sheet to be sure that our contact information (address, phone number, etc.) on file is correct. This is the only way that we contact you if there is an emergency, so please be patient when we ask for this information.

Insurance Companies and HMO's
It is extremely important that we have updated demographic data from both parents so that we will be able to contact you in the future. We also must have a current copy of your insurance card on file at all times. If your insurance changes, it is your responsibility to let us know as soon as possible and to inform us of the effective dates for your new policy. If prior encounters need to be refiled to a different insurance, you must notify us immediately due to Timely Filing requirements by your insurance. If we do not have your updated insurance information, then your claims may be denied for timely filing by your insurance and those claims would become your financial responsibility.

• Choosing an insurance plan or health maintenance organization can be very confusing. Managed care plans, such as HMOs, PPOs, POS plans, etc., have become the major choice for employers and patients.
• We recognize that health insurance premium costs are very high for our patients, and we will do our best to participate in the major plans offered in our area. However, there are some plans in which we do not participate so be sure that you check with our office before choosing a plan.
• Occasionally, we will terminate participation with a plan for various reasons. We will do our best to notify you of any changes, but you should contact our office periodically to be sure that we are still network providers for your plan. You can find a list of our more commonly accepted plans below. If we do not accept your plan, you will be responsible for the entire amount.
• You must decide which company best meets your needs based on the cost of the plan, range of benefits, reliability of the company, and the options given to you by your employer. We encourage you to choose carefully, since not all companies are the same.
• We also encourage you to become very familiar with your particular plan's requirements concerning eligibility, referrals, co-payments, deductibles, and covered services. Each plan may cover different types of services, and it is your responsibility to know what is covered by your insurance. There are far too many plans available for us to know the exact requirements of each plan.
• Many insurance plans do not cover checkups for children or they cover only a certain number of checkups. If these services are not covered, then you are responsible for payment.
• Your insurance policy is a contract between you and your insurance company for the company to provide benefits if an illness or injury meets conditions set by the company. Your insurance policy is not a contract between your insurance company and us. Our agreement is between you as our patient and us as your physician provider. You are responsible for knowing the obligations and requirements of your insurance plan.

Participating Insurance Plans
The physicians of PAA participate with the plans listed below and are accepting newborns and new patients with these plans. If you have any questions, please contact our Business Office at (859) 276-2005.

• All Aetna Plans
• All Blue Cross Blue Shield Plans
• CHA
• Healther Star
• PHCS
• Many other commercial plans
• Beech Street
• All Bluegrass Family Health Plans
• All United Healthcare Plans
• Humana (Not Humana HMO)
• The Physicians Network (TPN)
• All Cigna Plans available in area

Closed to Medicaid

Payment Options

Payment at Time of Service

• Patients are required to pay for their portion of the office visits at the time that services are rendered. This includes co-pays, deductibles, co-insurance and patient portions.
• We accept cash, checks, money orders and major credit cards (Visa, MasterCard, American Express, and Discover).
• If all or a portion of your bill is covered by insurance, we will file for that amount but ask that you pay your required portion at the time of service.
• It is important that you pay these at the time of service so that you can avoid having to pay large balances that have been accumulated over time.
• The person who brings the child to the office is responsible for payment of any patient due amounts.
• In accidents, legal cases, divorce, or other cases in which a third party is presumed liable for your expenses, the office expects the party receiving services to provide payment.
• We will be happy to furnish a receipt so that you can be reimbursed. Please keep your receipt as your proof of payment.
• You will receive a statement each month for any unpaid balance. Please pay your outstanding amount promptly. If you are concerned about a possible discrepancy with your bill, please call our Business Office at (859) 276-2005 immediately

Referrals

Some of the insurance plans require a referral from a primary care physician for specialty services, diagnostic services, rehabilitation services, etc. Each plan is different. You should be familiar with the requirements of your plan concerning referrals. There may be certain procedures or treatments that can be administered by the primary care physician as effectively as a specialist. For this reason, we as your primary care physicians need to make a medical determination if a referral is required.

You need to know whether your insurance plan requires a referral for specialty visits.

If referrals are required by your insurance, please do not make appointments with specialty physician offices without a referral. Managed care plans require that your primary care physician make the determination whether a referral is needed or not.If the insurance determines that the primary care physician did not approve the appointment, then you may be responsible for the entire bill from the specialist.

Please be patient with our staff when requesting referrals. We receive numerous requests and must be careful to accurately complete the paperwork.

Many insurance companies require pre-certifications and prior authorizations for diagnostic testing such as CT Scans, MRIs, etc. You need to be aware of what is required by your insurance company.

Referrals for Emergency Care

If you have been instructed by one of our physicians or our answering service to seek care at an emergency room or after hours clinic, your insurance may require a referral or may not approve the visit. Since each plan is different, it is very important that you become familiar with your plan's requirements regarding emergency care. No one wants to worry about financial responsibilities during an emergency situation, so it is best to know the requirements ahead of time. If your insurance requires a referral for an ER visit, please contact our office on the next business day. You must notify our office of any ER visit to be sure that it will be covered.