Insurance, billing, and costs
Clear information about the health plans we accept and how you can pay for your child's care. We take most major commercial and Medicaid plans. A few plans we cannot take are listed plainly below - no surprises.
Plans we accept
Plans change often. Please check with your insurance company that we are in-network for your exact plan before your visit.
Commercial plans
- Aetna
- AdventHealth plans (including plans that ride on the AdventHealth network)
- Adventist Health System Employee Health Plan
- Ambetter Health (marketplace plans)
- Blue Cross Blue Shield (not MyBlue or Blue Select)
- Cigna (not Cigna's BayCare-exclusive network)
- Humana (commercial)
- MultiPlan / PHCS (Primary Network only)
- Oscar Health
- UnitedHealthcare (including UMR)
Medicaid plans
- Aetna Better Health
- Florida Healthy Kids (on Aetna Better Health or Simply plans)
- CHIP (on Molina plans)
- Molina
- Simply Health Care Plans
- Sunshine Health
- UnitedHealthcare Medicaid
Military plans
- TRICARE
Plans we are still being approved for
Our new group's approval is still being processed for these plans. Keep coming to your visits as usual. We will tell you as soon as approval comes through.
- Humana Medicaid
- AvMed
Plans we cannot accept
We are out-of-network for these plans. If you have one, you would pay for the visit yourself at our self-pay price.
- Not accepted: ChampVA
- Not accepted: Cigna's BayCare-exclusive network (a Cigna carve-out - other Cigna plans ARE accepted)
- Not accepted: Blue Cross MyBlue & Blue Select
- Not accepted: Health First Health Plans
We are part of Privia Medical Group.
Paying for your visit
No insurance? We charge families without insurance by the kind of visit their child needs. A visit costs more when it takes longer or the problem is more complicated.
| Visit | Seen in the last 3 years | New to us |
|---|---|---|
| A regular sick visit | $110 | $135.50 |
| A long or complicated visit | $155 | $203.50 |
| Your child's age | Seen in the last 3 years | New to us |
|---|---|---|
| Under 1 | $116.50 | $130 |
| 1 to 4 | $124.50 | $137 |
| 5 to 11 | $124.50 | $142 |
| 12 to 17 | $136 | $160 |
- You pay when you check in. If your child ends up needing more care that day, we bill you the difference. If they need less, we pay you back.
- We take debit and credit cards, including HSA cards. We do not take cash, checks or money orders. If you only have cash, you can buy a prepaid debit card at a store like Walmart or Publix and pay with that.
- A child we have not seen in 3 years counts as a new patient. That is a national billing rule, not our choice.
- Tests we do in the office, like a strep or flu test, cost extra.
- The vaccine itself is free for kids without insurance, through Florida's Vaccines for Children program. There is a small fee to give each shot - $24.01 per vaccine, a price set by the state.
Vaccine costs. For families with insurance, vaccines cost nothing extra. Kids with no insurance get the vaccine itself free through Florida's Vaccines for Children program at our office; there is a $24.01 fee to give each shot, a price set by the state. One catch we cannot always see in advance: a few private plans do not fully cover vaccines. If that happens, the plan makes the family responsible for the cost, and by law we cannot use the free program for privately insured kids. If your plan is one of these, a federally qualified health center can give the shots at low or no cost - ask us and we will point you there.
Copays and deductibles. Your insurance sets amounts you pay at the visit. A copay is the flat fee for a visit. A deductible is the amount you pay before your insurance starts paying. The amount depends on your plan and on the visit. Our front desk can tell you what to expect before you are seen. Please be ready to pay at the time of the visit. We take debit and credit cards, including HSA cards. We do not take cash, checks or money orders. If you only have cash, you can buy a prepaid debit card at a store like Walmart or Publix and pay with that.
Check before you come. Please make sure your plan is active, we are in-network, your child's primary care provider is set correctly, and no other policy is listed as primary on your account. This avoids surprise bills. We do accept secondary insurance.
New babies. Add your baby to your plan right away - most plans give you only 30 days. Our newborn care page walks you through every step, including Medicaid.
Bills and payments
Pay a bill online. Use our secure payment page. You will need the Statement Code printed on your statement.
Billing questions. The fastest way is a secure message through the patient portal. You can also call either office and choose the billing option.
Why did my "free" checkup have a copay?
A yearly well visit (checkup, shots, screenings) is preventive care. Most private plans cover it in full - no copay.
But if we also treat a separate problem at that visit - say allergies, or an ADHD medicine change - insurance counts that part as a sick visit, and your plan may charge its normal copay. The checkup part is still free; the extra care is not.
These rules come from federal law and your insurance contract, not from us. If a charge seems wrong, your insurance company is the right place to ask.
Card on file - how it works
At check-in, new patients (except Medicaid) provide a debit, credit, HSA, or FSA card, which we store securely.
After your visit, your insurance decides what you owe - the "Explanation of Benefits." We charge the card only that amount, so you never get chased by paper bills for amounts nobody knew at the visit.
Other fees
- FMLA forms: $60. Insurance cannot be billed for these, per the US Department of Labor.
- Immigration and IRS letters: $10.
Your rights against surprise medical bills
When you get care from our providers, federal law protects you from surprise billing. You have the right to a "Good Faith Estimate" that explains what your care will likely cost before your visit - just ask us.
Learn more at cms.gov/nosurprises.
Common insurance questions
What if I do not have insurance?
A sick visit costs $110 and a checkup costs $116.50 to $136, depending on your child's age. It costs more if we have not seen your child in 3 years. See the price tables on this page.
What should I bring to the visit?
Bring your child's insurance card (a photo on your phone works) and a photo ID. If your child is new to us, their shot records help too.
How do I add my new baby to my insurance?
Call your insurance soon after your baby is born - most plans give you only 30 days. For Medicaid, call (877) 711-3662 to activate coverage and pick us as the primary care provider.