• Transparency in Healthcare Billing Rates  -  (Effective July 1, 2024)
  The following information is made available to allow for transparency in the billing for services at Delavan Pediatrics, LLC.
  
  The standard charge for services is what is billed to an insurance company.  Each insurance company processes these charges according to the contract I have with them as well as your specific insurance plan benefits.  The amount owed by you, either as a copay or deductible, after processing will be based on these factors.  Any bill sent by this office to you will reflect the results of the determination made by your insurance plan.  Any questions should first be directed to your insurance plan.
  
  Service levels are based on medical decision-making complexity and/or time spent.  Most office visits are billed at the Moderate level.  Simple focused visits such as looking at a mole or a diaper rash would be billed at the Straightforward level.  More complex visits such as ADHD/mood medication follow up would be billed at the Complex level.  Visits being billed as Prolonged are unusual.
   
  We are pleased to offer our uninsured patients a “Time of Service” discount for billed charges pertaining to all provider visits, laboratory testing, and vaccinations.  At this office we have one standard fee schedule for all services.  This is the fee that is charged to our contracted insurance companies.  These standard charges are higher to account for contracted discounts with the various insurance companies and to cover costs associated with the use of our billing service and insurance clearinghouses.  For the uninsured, we do not have these extra expenses to cover and we are able to pass these savings on to you in the form of a “Time of Service” discount.  The offering of this discount is part of our agreement with you in the same way that this office has negotiated discounts with the different insurance companies.  The following is our standard fee schedule for the expected pre-discount charges for requested services along with the agreed upon discounted charges after the “Time of Service” discount has been applied.  Across the board, the “Time of Service” discount is equal to 30% off the standard billed charges.
  
  For those with insurance opting to pay at the time of service due to uncovered services or a high deductible, the “Time of Service” discount is available, but it is important to remember that these discounted fees cannot be submitted to the insurance company for reimbursement or to be applied to your deductible.  For those with health-sharing ministries any shareable charge can be submitted per the ministry guidelines.
  
  If you are unable to pay at the time of service, the standard charge will apply and the “Time of Service” discount cannot be applied.
  
   
  OFFICE VISITS (ESTABLISHED PATIENT):  
  Visit Type                         Billing Code                       Standard Charge                  Discounted Fee
  Nurse Visit                           99211                                           $60                                              $42
  Straightforward Visit     99212                                          $110                                             $75
  Moderate Visit                  99213                                          $157                                            $105
  Complex Visit                     99214                                          $204                                           $135
  Prolonged Visit                 99215                                           $242                                           $165
  Well Child Exam                 Any                                               $212                                            $140
  
  
  OFFICE VISITS (NEW PATIENT):
  Visit Type                           Billing Code                      Standard Charge                    Discounted Fee
  Straightforward Visit        99202                                          $157                                              $105
  Moderate Visit                     99203                                          $228                                               $150
  Complex Visit                        99204                                          $315                                               $205
  Prolonged Visit                    99205                                           $375                                              $245
  Well Child Exam                    Any                                               $235                                              $155
  
  Notes:  Pre-Op physicals are generally billed as 99213 or 99202 unless they are done at the same time as another visit then different charges may apply.
  
  Visit type pertains to complexity (review of systems, physical exam, and time spent by Dr. Flint inside and outside of visit).  Consultations where no exam of the patient is done will be billed based on time spent.  The time-based component for the visit types are as follows: 
   
  

IN-OFFICE PROCEDURES:
Procedure                                                           Standard Charge                                  “Time of Service” Fee
Strep Test                                                                         $40                                                                      $30
Urinalysis                                                                         $20                                                                       $15
Hemoglobin                                                                    $20                                                                       $15
Glucose                                                                             $10                                                                     $7.50

VACCINES:
For self-pay families without insurance, vaccines are covered through the state VFC program.  There is a $18.00 fee associated with each vaccine given as an administration charge.
 
If you have any questions about the “Time of Service” discount, please do not hesitate to ask Dr. Flint.