Insurance information

CDPCA participates with the following list of medical insurances. If you are a member of a participating insurance plan, it is your responsibility to ensure that all necessary referrals or authorizations are complete prior to your visit:

             Capital District Physician’s Health Plan (CDPHP)

MVP Health Care (includes MVP/Cigna)

Blue Shield of Northeastern New York (includes BC/BS Federal Employee Program)

Empire Plan (includes state employees United Healthcare)

Empire Blue Cross Blue Shield (does not include Excellus)

New York Medicaid

Vermont Medicaid

Medicare

Wellcare Health Plans

Fidelis Care

Aetna

Hudson Health Plan

Tricare

National Health Administrators PPO               

If we do not participate with your insurance plan, we will make every effort to facilitate your evaluation here. For out-of-network visits, your out of pocket costs may be less if you obtain in-network authorization for your visit. It is your or your primary care provider’s office responsibility to contact your insurance company to get prior authorization as an “in-network physician”. When doing this, remember to get the authorization number and the name of the person with whom you spoke. If the insurance company asks you if there are any in-network providers, please tell them that we are the only full service Pediatric Cardiology group in the region. We can help you to obtain in-network authorization from your insurance company, as well as how to file and follow-up on insurance claims.

Please bring a copy of your insurance card and a state issued identification at the time of your appointment.

Co-payments are due at the time of service. For your convenience we accept cash, check, and credit cards (American Express, VISA, Mastercard and Discover).

The amount/charges or estimated amount/charges of provided services is available upon request.  Upon receipt of a request, the amount or estimated amount that will be billed (or the fee schedule if a health center), absent unforeseen medical circumstances, will be provided (this information will be provided in writing).

After your visit, we will file an insurance claim with your insurance company.

-          For participating insurance plans: after payment is received from your insurance company, you will be responsible for any remaining co-pays, deductibles and co-insurance not covered by your contract (such as in high-deductible plans).

-          For out-of-network insurance plans: even if the visit is considered “in-network”, you will be responsible for all uncovered charges, including co-pays, deductibles and co-insurance. Any insurance payments made directly to you should be forwarded to Capital District Pediatric Cardiology Associates. Please save any “Explanation of Benefits” (EOB) forms sent by your insurance company.

Invoice amounts not paid and postmarked within 30 days may be subject to a monthly service fee not to exceed 2% per month of the outstanding balance plus additional collection costs incurred to collect amounts that are 120 days past due. Accounts more than 120 days past due will be reported to a collection agency unless you contact us and we agree to a payment arrangement.

Payment plans are available for families with large balances. CDPCA also has a financial hardship policy by which you may apply for a reduction in any payments that are due.

Please also refer to our Patient Financial Policy And Responsibility For Payment form.