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Services at Rivergate Pediatrics

Age of patients

We care for newborns to college age young adults and accept new patients under 18 years of age.

Triage Nurse and Over-the-Phone Care

Does my child need to see the doctor? If you are unsure, our triage nurses can help you decide when to schedule an appointment and how much time to schedule. They are also available to provide advice and follow-up for many of the pediatric illnesses that require home-care only. Our triage nurses work in our office and are in constant consultation with the physicians. When Over-the-Phone Care is not appropriate, they will help you schedule an appointment.

Sick Visits

Acute illness (one week or less) 

We can usually see you and your child for a same-day appointment. If you cannot call until later in the day the triage nurse can help schedule your appointment with an after-hours visit or a next-day appointment.
Non-acute illness (greater than one week)
Visits for non-acute illnesses generally need more time and may not need to be scheduled the same day. We will make an appointment that is appropriate and convenient for you and your child; the triage nurse can help you if you are unsure when your child needs to be seen.
Follow-up visits
These short visits are usually scheduled at the time of a sick visit appointment to make sure the illness has resolved or a chronic condition is improving or stable. Some follow-ups can be done over the phone as a “virtual visit.”
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Well Visits

Check-ups
These preventive medicine visits require the most time and usually need to be scheduled in advance. Although the content of the check-ups change with the age of your child, there are some things that we always check in order to promote wellness or to identify problems. Please be aware that some insurance companies' "100% well care coverage" may not cover all of the medically necessary and recommended elements of a pediatric check-up.
Pediatric Check-up visit
  • Weight, height, body mass index (BMI)
  • Nutrition
  • Sleep habits
  • Age Appropriate Screening for:
    • Physical and Developmental Milestones
    • Social development and parent/peer relationships
    • Cognitive development and academics
    • Emotional health and development
    • Risks to health and safety
  • Family Medical and Social History
  • Physical Exam
  • Hearing and Vision Screening
  • Immunization update
  • Preventive Health Recommendations
  • Adolescent Issues (see Letter about confidentiality)
If a health concern is identified in any of the areas listed above or if your child has an acute or chronic illness that requieres time to evaluate and treat above and beyond all of the other aspects of a well check, and if time allows, these concerns can be addressed during the same visit. If the issue can be addressed later or requires more time, a follow up appointment will be arranged. In either case there will be and additional visit charge and copay.

IMPORTANT INFORMATION CONCERNING

SPORTS PHYSICALS 

From 11 years-old and up we include the specialized history and musculo-skeletal exam required for a sports physical during your child’s annual check-up IN ADDITION TO ADDRESSSING ALL OF THE ABOVE ISSUES.
If your child participates in TSSAA sports, he or she must have a physical after May 1st. We feel strongly that a “sports physical” at school or urgent care is not a replacement for an annual check-up. 
If your child has not had a complete physical within the past 12 months we will schedule your child for a complete physical and complete your sports form during that visit. This physical will be filed to your insurance and copay/co-insurance will apply. 
If your child has already had a checkup within the past 12 months we will be glad to fill out the form. 

  Download the required form here, fill out your part and bring it with you.

Follow-up visits
Check-ups can generate follow-up visits as well. If a concern is identified in any of the areas listed above, the physician will ask you to schedule another visit to diagnose, discuss, and treat that issue. These visits vary in length, and will be scheduled based on the amount of time you and the doctor feel necessary.
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Vaccines

 Rivergate Pediatrics participates in the Vaccine for Children program which offers free vaccine for TennCare and uninsured patients. We follow and endorse the immunization schedule recommended by the American Academy of Pediatrics.

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Payment & Billing Policy

Your Financial Responsibility

 A significant part of the trust involved in the Doctor-Patient relationship involves each person fulfilling  their responsibilities toward each other. One of the patients, or parents, responsibilities is to pay for services provided.  Please read and be familiar with the policies below. 

First Visit

New patients are asked to pay on the day of their first visit, and until their credit has been established. Insurance co-payments are always due at the time of service.

Payment

We accept cash, checks, Debit cards, and all major credit cards. Payments may be made by mail or by calling 859-6650. Statements with an outstanding balance must be paid within 30 days. All accounts over 90 days old are considered delinquent and subject to collection.

Co-payments

Copayments must always be made at the time of service. We cannot bill you for your co-payment! Even though your insurance may cover well checkups at 100% a separate copay and deductible may apply if an additional service is provided.  For example, during your child’s annual well checkup our physicians discuss (with you or your child) issues of normal growth, development and wellness. They will review family, medical and social history, perform a complete physical exam and order any recommended periodic screening tests. Your child may have other significant and separate health issues (asthma, migraines) or new acute illnesses that you may want to discuss with your physician on the same day as your check up. If time is allowed, our doctors are willing to discuss these specific concerns or illnesses at that time so you do not have to schedule another appointment. This may require a separate office visit charge and copayments will apply.

Coordination of benefits

When you have two insurance policies, you will need to inform both insurance companies that there is other insurance so that they can coordinate benefits to determine which should be filed as primary and which one secondary.  The insurance companies will not take the information from us. The insured must call. As a general rule, primary is determined by the birth dates of the insured parties. The birth date that comes first in the year is usually primary. There are other circumstances in the case of divorce and court orders that would change this rule. Your insurance company will tell you what they need. If you have any questions, please feel free to contact our billing and insurance department. We will be happy to do whatever we can to help you co-ordinate your policies to avoid problems with payments.
PLEASE NOTE: TENNCARE WILL ALWAYS BE SECONDARY IF YOUR CHILD IS COVERED UNDER ANY OTHER INSURANCE. FAILURE TO NOTIFY TENNCARE OF OTHER INSURANCE COVERAGE IS CONSIDERED FRAUD.

Insurance Plans

We will bill your insurance plan or provide a form for you to file. You will be billed for any balance due (deductible, non-covered services) after the claim is paid by your insurance company. All balances are due within 30 days. You are responsible for any and all co-payments, deductibles, and co-insurance. You are required to provide us with complete insurance information on primary and/or secondary coverage. We will ask you to update your  insurance information at each visit. You need to understand your insurance plan. All medically necessary care may not be covered.  We have experienced insurance staff who can help answer your questions, or you can get help from your plan sponsor (employer) or  the insurance plan itself.  We currently have affiliations with the insurance companies listed below. We will use our knowledge and experience to help you understand the terms of your coverage, but it is your responsibility to be familiar with the details of your policy, and be responsible for payment. Even if your insurance company appears on the list below, please call the billing and insurance department at (615) 543-2270 to ask our insurance specialists if we participate in your insurance plan.

  • Aetna
  • Amerigroup
  • United Healthcare Community Care
  • Blue Cross/Blue Shield  (Networks S, P, E, TennSelect)
  • Cigna Healthcare (except Cigna Connect)
  • Great-West
  • Healthsprings (HMO)
  • Humana Choice Care
  • Humana Tricare (Standard Only)
  • Multiplan/PHCS
  • United Healthcare

Deductible

Until you have met your deductible, we require payment at the time of service. Copayments and outstanding balances will be collected at your visit.  

Self-Pay Patients
Payment is required at the time of service. Established patients who ae unable to pay at the time of service should make payment arrangements with the billing department.
 

Non-covered services 

Not all insurance plans cover annual physicals or some of the recommended screening tests (vision, hearing and developmental). Some have an arbitrary limit on the number of well visits and may not cover immunizations.  Although we try to be aware of insurance policy restrictions on covered care, we must continue to provide quality care and you may be responsible for the uncovered costs.  If immunizations are not covered, you may consider obtaining these at your local Health Department.  We participate in the Vaccines for Children Program which provides vaccines for Medicaid and uninsured patients under the age of 19. Uninsured patients aged 19 and older may receive recommended vaccines at the health department. The vaccines are free and the administration fee may be discounted based on income. Please check with your local health department for availability.

Newborns

Please contact your insurance company or employer to enroll your newborn on your insurance policy. Most insurance companies require this to be done within 30 days of birth. Failure to enroll your child within the guidelines of your insurance policy can result in ‘late enrollment’  provisions. This could reduce your benefits or cause a break in insurance coverage for the newborn. If you have any questions, please contact our insurance department. If you have any denied claims, please contact the insurance company or call us when the child is added so that we can resubmit claims.  Sometimes a child is covered under the mother’s policy for the first 31 days, even if you do not enroll the child under that plan. Please bring it to our attention if there are two different policies at any time so that we can coordinate the coverage to prevent duplicate payments.

REMEMBER:BY LAW, TENNCARE WILL ALWAYS BE SECONDARY TO ANY OTHER INSURANCE. YOU MUST PROVIDE US WITH ALL INSURANCE INFORMATION

Other Charges

        Forms:   No charge for immunization forms.

                     Special Forms (camp, sports, special olympics): No charge for one form per year

                     $20 charge for Family Leave Act form or Letters of Professional Opinion

        Returned Check Fee: Managed by Check Velocity 1-800-320-8545  

        Medical Record Charges: Medical Summary - No charge

        Copy of Record: $20.00 for first five pages, then $0.50 per page                   
 

For Billing and Insurance Questions

                615-543-2270

                877-467-6565 (toll free)

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