Financials


We appreciate your promptness in arriving for your visit. We reserve a specific time for your according to your needs and level of complexity. Please be aware that appointments are limited and in high demand. Dr. Sullivan devotes a substantial amount of time to each of his patients, so it is important to arrive early and avoid the possibility of missing out on your allotted time.

We value your time and we do our best to remain on schedule throughout the day. We do ask that you please remember that each patient in our office is an individual and some may require more patience and “TLC” than others. We make every effort to stay on schedule, however things do happen from time to time. In order to accommodate that, our schedule may be delayed. Please accept our apologies ahead of time should such a delay occur during your appointment. Understand we will do exactly the same if you are ever in need of extended care.

Since appointed times are reserved exclusively for each patient we ask that you please notify our office at least 24 hours in advance of your scheduled appointment time if you are unable to keep your appointment. We realize that unexpected things can happen, but we ask for your help in this regard. We do reserve the right to charge a $50.00 fee for missed appointments.

Payment for professional services is due at the time treatment is provided. Our office accepts cash, personal checks, debit cards, VISA or MasterCard and Care Credit. A $20 overdraft will be charged to your account for each returned insufficient check.

Please be aware that the parents bringing a child to our office are legally responsible for payment of all charges. We cannot send statements to other people.

If we have received all of your insurance information on the day of the appointment, we will be happy to file your claim for you. We are an in-network provider with Blue Cross/Blue Shield. As a service to our patients, we will bill insurance companies for services as long as they will send payment directly to our office. Any portion not covered by your insurance due to co-pays, deductibles, etc. will be billed to you. If you have not paid your balance within 60 days a finance charge of 1.5% will be added to your account each month until paid. If your account becomes 120 days past due it may be turned over to our collection agency. You will be responsible for all cost of the collection.

PLEASE UNDERSTAND that we file insurance claims as a courtesy to our patients. We do not have a contract with your insurance company, only you do. It is your responsibility to be aware of your insurance company and your benefits. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. We can only assist you in estimating your portion of the cost of treatment, we at no time guarantee what your insurance will or will not do with each claim.

Fact 1 – NO INSURANCE PAYS 100% OF ALL PROCEDURES

Health insurance is meant to be an aid in receiving care. Many patients think that their insurance pays 90%-100% of all fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage, or the type of contract your employer has set up with the insurance company.

Fact 2 – BENEFITS ARE NOT DETERMINED BY OUR OFFICE

You may have noticed that sometimes your insurer reimburses you or the doctor at a lower rate than the actual fee. Frequently, insurance companies state that the reimbursement was reduced because your doctors’ fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable, or well above what most other offices in the area charge for a certain service. This can be very misleading and simply is not accurate.

Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may vary widely, because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently, this data can be three to five years old and these “allowable” fees are set by the insurance company so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your doctor is “overcharging”, rather than say that they are “underpaying”, or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

Fact 3 – DEDUCTIBLES & CO-PAYMENTS MUST BE CONSIDERED

When estimating benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150. Assuming that the insurance company allows $150 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First a deductible (paid by you), on average $50, is subtracted, leaving $100. The plan then pays 80% for this particular procedure. The insurance company will then pay 80% of $100, or $80. Out of a $150 fee they will pay an estimated $80 leaving a remaining portion of $70 (to be paid by the patient). Of course, if the UCR is less than $150 or your plan pays only at 50% then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.