Insurance & Billing

We accept most insurance carriers

Check your insurance is in our Commonly Accepted Insurances listed below:

Note: If your insurance is NOT listed below then please send a copy of your insurance care (front/back) along with Patient's First/Last name, Date of Birth and Reason for initial visit to info@penguinpediatrics.com.

For any Billing Information Call 571-223-6848

Most insurance companies share costs with the patient. There are many cost sharing options:

Deductible

The total amount of covered medical expenses that must be paid by the patient before the insurance company begins paying benefits. After this requirement is reached, the insurer will begin paying according to the terms of the contract of covered medical costs. The patient is responsible for any remaining balance

Flate-Rate Copayment

The patient pays a share of covered medical costs and the insurance carrier pays an amount based on the policy. For example, the patient pays $15 of any office visit charge and, the insurance carrier is responsible for the balance.

Percentage-Based Copayment:

The patient pays a percentage share of covered medical costs and the insurance company pays an amount based on the patient's policy. Examples are: 20% of the office visit charge - $10 of a $50 charge, $12 of a $60 charge, etc. Typically, this copayment arrangement includes a deductible and may have other variations.

Consumer-Driven Health Plans (CDHPs)

(CDHPs) are the fastest growing plan type currently across the country. Employers are shifting financial responsibility to their employees by offering health plans with high deductibles and coinsurance to reduce cost to the business. Most of these plans cover wellness services such as immunizations, well-child visits and periodic check-ups more than sick services. They usually have a high deductible, but when the deductible is met, the plan pays for services at a percentage (such as 80%) of a defined reasonable and customary fee schedule.

Health Savings Accounts (HSAs)

(HSAs) are tax-favored savings accounts funded with pretax dollars by the individual or the employer. Money can be withdrawn from the account at any time with no penalty or taxes to pay for qualified medical expenses. An HSA can be established only along with high-deductible health insurance plans that meet Internal Revenue Service rules that set the amount of the individual and family deductible. The amount an employee can put in an HSA is capped at the amount of his or her annual deductible of his or her health insurance policy. Any unused funds each year remain in the account, accumulate tax-free and can be used for future medical expenses.

Health Reimbursement Accounts (HRAs)

(HRAs) are funded by the employer and can be used by an employee as pretax dollars. These accounts can be set up independent of any specific health plan or benefit design. Money can be used to pay for medical expenses. HRA funds can also be carried over from year to year. The amount of the contributions to the HRA varies based on the employer. The employer owns the fund and any unused amounts may or may not be transferred on termination of employment depending on the terms of the fund. Medical spending accounts (MSAs) and flexible spending accounts (FSAs) are versions of HRAs with particular features.