Insurance Information

GPM Pediatrics, PC participates with most insurance plans. Please bring your insurance card with you during every visit.
We currently accept: 

  • 1199 National Benefit Fund
  • Aetna - HMO & PPO
  • Amerigroup/Health Plus (PANEL CLOSED*)
  • Anthem
  • Beech Street
  • Cigna
  • Emblem Health/GHI
  • Emblem Health/HIP
  • Empire BC/BS - HMO & PPO
  • First Health
  • Healthnet - PHS
  • Horizon PPO (Blue card ONLY)
  • Humana/Choicecare Network
  • Magnacare
  • Multiplan
  • NY Government Plan (United HC Empire Plan)
  • Oxford
  • PHCS
  • Tricare
  • United Healthcare 
  • US Family Healthplan
  • Most Union Plans Accepted
Affordable Care Act Plans we accept:

  • Aetna NYC Community Plan
  • Empire BC/BS
  • Oxford Health Plan (Liberty)
  • Oscar Health Insurance - no longer accepting after 12/31/16
‚Äč***We DO NOT accept Emblemhealth Gold or any EmblemHealth Select Care Network Plans.  This means NO GHI or HIP that say SelectCare or Gold on them***

* PANEL CLOSED:

Patients currently on this plan will continue to be seen by our practice; however no additional patients can go onto these insurances, please contact our office for more information.

Additional Notes:

  •  Most Union Plans Accepted
  • We do not participate with Medicaid directly
  • GPM Pediatrics, PC does not accept secondary insurances; however we will gladly provide you with a receipt to submit to your insurance.
  • We do our best to stay on top of each patient's 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 that 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.
  • Please note that should any member of your family be admitted to the hospital, please follow your insurance company requirements to reduce your risk of payment problems.

Important Note for Parents:
It is extremely important that you add your new baby to your insurance policy once your baby is born. Most insurance plans have a 30-day grace period for newborns to be added to the policy. Once the grace period has expired, the parents will be responsible for charges incurred if the baby is not added. Please remember to bring your insurance card, copay, and patient forms to your first visit.

Billing & Payment

 
GPM Pediatrics, PC wants to help you understand your medical bill and will always provide clear information regarding the billing details of the provided health care services.
In order to assist you in that understanding, we have defined below the common billing terms.

  • Co-Payments

Co-payments are a contractual agreement between the policyholder 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 policyholders’ 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.

  • Co-insurance

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 policyholder would be responsible.

  • Non-Covered procedures

The policyholder receives the explanation of benefits (EOBs) 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 EOBs will determine what the policyholder 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 GPM Pediatrics, PC are based on the contractual agreements you have with your carrier.

For Billing inquiries/insurance questions, please contact Billing at:
Phone: 718-982-6800
Fax: 718-698-3730
Email: billing@gpmpediatrics.com

We expect payment of your copay at the time of service. For your convenience we accept cash, check and the following credit cards:

amex.gif mastercard.gif visa.gif discover.gif

Monthly payment arrangements can be set up, please contact Billing at 718.982.6800 or via email at billing@gpmpediatrics.com.

PAY YOUR BILL ONLINE

In This Section

Is Your Child Sick?TM

Select from over 100 symptoms to read more about managing your child's illness.

What's Going Around?

7715 4th Avenue Brooklyn, New York 11209 phone: 718.833.2300 fax: 718.836.2305
1779 Richmond Avenue Staten Island, New York 10314 phone: 718.982.6800 fax: 718.982.6830