Updated Billing Policy: Call & Portal Messages

In the past, Potomac Pediatrics has included telephone advice calls and portal message advice as part of our annual non-covered services fee (NCSF).

One major change coming this year is that we are actually pulling these services out of the NCSF, and instead when it’s applicable, we’re going to bill these services to your insurance company.

To clarify a few definitions:

  • Covered services are things that are covered by your insurance that we can bill to your insurance. The easiest examples are in office visits such as sick visits and check ups.
  • Non covered services are services that we provide at Potomac Pediatrics that aren’t covered by your insurance company and can’t be billed through them.  Examples include health forms and prescription refills.  

***What’s determined to be covered versus non covered is determined by your insurance company and not by us at Potomac Pediatrics****

So why are we making this change this year? 

First, medical billing and insurance practices have changed pretty drastically over the past few years. These services like phone calls, portal messages, and other similar encounters were not previously considered part of an office visit not as a separate encounter. However over the last couple of years, almost all insurance companies now list these remote encounters as separate covered services as they are often independent encounters and not related to an office visit.  As covered services, we are no longer permitted to include these telephone/portal encounters as part of the NCSF and are now required to bill them through the insurance company based on our contracts with your insurance company..

Simply put, this is how your insurance company now requires us to bill and get paid for our time.

Second, we recognize that convenience and efficiency in medical care is more important now than ever. Phone calls and portal messages are really valuable services that are utilized by a lot of our busy families. We want to continue to be able to provide these services so you can access care in a convenient way. Pivoting our billing practices allows us to continue these offerings in a sustainable way.

We understand that not all phone calls are created equal. Simple phone calls that are asking simple questions or simple questions that you are messaging through the portal certainly will not be billed. Specifically, we will be billing for calls and portal messages that require more than 5 min of our time to complete.

While the billing practices for these services are changing this year, we are committed to continue to provide the high quality care and service that you have come to expect from Potomac Pediatrics.

 If you have questions about this transition, please reach out to a member of our team.