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Insurance Information

Valencia Pediatrics accepts many PPO insurance plans.

The following is a list of the bigger insurance companies we are contracted with:

  • Blue Cross
  • Blue Shield
  • Aetna
  • Cigna
  • United Healthcare
  • Motion Picture Industry Health Plan

We are also contracted with many other smaller insurance companies.  Please contact our billing department at (661) 294-2229 option 4 or your insurance company to see if we are contracted with your insurance carrier. For established patients please use our Patient Portal to send a secure message to the billing department.

Insurance Coverage

Bring your child’s insurance card to every appointment.  If your child has secondary insurance, be sure to bring that card as well.  When you check in at the front desk, we will ask to see and verify your child’s insurance card for our records.   We need your current insurance information for accurate claims submission.  If we are contracted with your plan, we will bill the insurance company for the services we provide.  If we are not contracted, we cannot bill for you, and payment is expected at the time of service.  We accept cash, checks, MasterCard, and Visa.

Changes in your insurance

Make sure that you provide us with the most current insurance information when you come to the office and at any time there is a change. It is important for us to have the complete name of the insurance company, correct billing address, name and date of birth of the policyholder, effective date, and any applicable ID numbers and group numbers.  We are only able to bill your new insurance with a valid insurance card.  Delays in communicating these changes may result in the balance being uncollectible from the insurance company and the full responsibility for payment will fall upon the parent/patient.

Co-pays, deductibles, and co-insurance

Valencia Pediatric Associates collects all patient co-payments, coinsurance, and deductibles at the time of service.  If your child is sent with a caregiver, please make sure that that person is prepared to make that payment. If a balance is due, after your insurance company has processed your claim, a statement will be sent to you.  Valencia Pediatric Associates expects payment within 30 days after a bill is generated.   

The best tip that we could give any of our patients is to know and become familiar with their insurance plan and its benefits. Some plans cover nearly all office services.  Others exclude well care, immunizations, labs, and other procedures.  In some cases you are required to pay out of pocket expenses such as deductibles or coinsurance.  Every plan is different.  We encourage you to contact your insurance company if you have any questions about your benefits such as:

  • Do I have well child or preventive care for my child? 
  • What procedures are not covered during a well child or preventive care visit?
  • Is there a limit or maximum benefit to the well child or preventive care?
  • Are the vaccines covered by my insurance?
  • Are there vaccine coverage limitations?  We follow the immunization guidelines established by the American Academy of Pediatrics (AAP) and the Center for Disease Control’s Advisory committee on Immunization Practices (ACIP).  Nevertheless, some plans have complex regulations about when they will and will not cover vaccines and well care.
  • If my child is having an office procedure done, such as care for a fracture, laceration repairs etc.: what will I be responsible to pay?
  • How much is my copayment? Coinsurance? Deductibles?

For our patients with Motion Picture Insurance:  In order to utilize your full benefits with the Industry Health Network please call 1-800-876-8320 to obtain a onetime referral to our practice.  Without this onetime referral, you’re insurance company will not pay your claims at 100%.

Newborns and Insurance

Most insurance companies require you to add your newborn within a 30-day period.  As a courtesy, Valencia Pediatric Associates gives you 2 weeks in which to do this.  Any visits during that time will be billed to your insurance company for future processing.  If you’re newborn has not been added by the 2 week check we will request payment at the time of service.  If you subsequently provide us with an insurance card within 30 days, we will bill the charges to your insurance company for you.  If we then receive an insurance payment we will be happy to issue a refund to you or place a credit on your account.

Well Child Visits and Immunizations

Insurance companies will normally process these claims as “Preventive Care”.  Please note that some insurance policies do not cover this type of service or only cover it until a child reaches a certain age.  Although insurance claims will be submitted by our office to your insurance company, it is the parent’s responsibility to understand and comply with their specific coverage benefits.

 Sometimes during a preventive health visit the physician will diagnose and treat another problem.  Services for the other problem will be billed as an additional charge.  Some insurance companies will not cover two office services on the same date so payment for one of them may be denied by the insurance company or an additional co-payment may be required.

Valencia Pediatric Associates submits claims to insurance companies providing the exact services performed and the exact reason for performing them.  Sometimes insurance companies may not pay all charges as they were submitted by Valencia Pediatric Associates.  We cannot change the diagnosis code or a procedure code after the original claim submission (unless it is initially submitted incorrectly) so the claim or some of the services can be paid by the insurance company.

*Please note: Insurance Companies often take months before covering new procedures (i.e. vaccines) regardless of the current recommended medical guidelines.  Since providing quality care to our patients is our primary concern, we encourage you to contact your insurance carrier to determine coverage for such treatment.  Please understand that you may be required to assume full financial responsibility for these services if they are not covered under your plan.

Insurance Claims Processing

After receiving a claim for services some insurance companies request additional information from the subscriber.  If you receive such a request, please respond immediately.  Claims will not be processed unless they hear from you.  This could lead to you assuming full financial responsibility for these services.

Financial Responsibility

Regardless of court designated responsibilities, we hold responsible for payment the adult who brings the child into the office for care. 

If parents are DIVORCED, whoever brings the child into the office is responsible for co-pays and for having a current insurance card.

We must emphasize that our relationship is with you and not your insurance company.  Since we have no control over what your insurance company will pay for, you will need to question and/or dispute disagreements with them personally.  All charges are your responsibility from the date services are rendered.  We realize that temporary financial problems may affect timely payment of your account.  If such problems arise, you must contact us promptly for assistance with the management of your account.  Our billing office can be reached directly at 661-294-2229 option 2 (during normal office hours) to answer any of your questions.