Insurance & Billing

We do accept self-pay patients. Payment is due in full for well visits at the time of service. For sick visits or any other encounters, you will be asked to pay a minimum of $100 down payment for the visit and after the Clinician has finalized the encounter you will receive a statement of the balance due.

If your plan has a deductible that needs to be met prior to your reposponsibility being copayment or coinsurance only then you will be asked to pay $100 minimum payment at the time of service. After the claim is received back from the insurance we will balance bill you with a statement if there is any additional patient responsibility.

• As of January 1st, 2018, MPA is no longer a Medicaid Provider. This means that we cannot bill our services to Medicaid policies of any form, whether it is state Medicaid or commercial Medicaid (such as from BCBS). Patients who are covered with a Medicaid policy (either as Primary or Secondary) may still come to MPA as Self-Pay patients, but please know that our Clinicians cannot be listed as your child's PCP since we are no longer participants. This may cause complications with referrals to specialists or prior authorizations.

• As of January 1st, 2022, MPA will no longer be accepting share plans. Patients who OPT for this type of alternative plan may be Self-Pay patients with us and may still turn in their expenses to their share plan for reimbursement, but MPA will not bill to these plans.

• Any insurance that will not accept electronic claims. Your insurance card should have an EDI or Payor ID to indicate that electronic claims are accepted. If you cannot locate this number you may call our billing department for assistance.

It is very important to ensure that the PCP (Primary Care Physician) for your HMO or HME plan be listed as one of our licensed physicians. If your PCP is one of our licensed Pediatric Nurse Practitioners then that NP's supervising physician will need to be listed as the PCP. Care can be delayed or interrupted in urgent situations if this is not maintained. This process is the responsibiilty of the subscriber. 

Note: A lot of these plans will only list the subscriber's PCP on the card making it difficult for us to assist you in knowing if your child's PCP is identified as one of our Physicians.

This is the reason for the majority of our denied claims. We will notify you every time this occurs but, COB is not a denial reason that can be fixed by your doctor or their billing department. This is an issue only the subscriber of the insurance plan can fix. It is important to note that if a COB issue is never fixed the cost of the services that were rendered can become the burden of the patient. To avoid that, follow these tips and reach out to our office if you have any questions or would like to learn more. 

To determine which plan is primary for dependent children covered by more than one health plan, insurers use the birthday or genter rule. 

• If the health plans of both parents use the birthday rule, the plan of the parent whose birthday falls earlier in the year (month and day) is the primary for the dependent children. If the month and day are the same, the policy that was in effect first is primary. 

• If the health plans of both parents use the gender rule, the father's plan is always primary for dependent children. 

• If the health plan of one parent uses the birthday rule and the other uses the gender rule, the gender rule prevails, and the father's plan is primary. 

• There are exceptions when a divorce decree determines which health plan is primary. This is not to be confuxed by a decree mandating that coverage be the responsibility of one or more guardian. Maintaining coverage of a dependent and mandating that coverage is primary are not the same thing and each would be clearly defined if contained in a divorce decree.