Insurance Information

Accepted Insurance Carriers:

Below is a list of insurance carriers that Penfield Pediatrics physicians participate with. Each carrier may offer several different plans, and Penfield Pediatrics may not accept them all.  Please contact your insurance carrier to learn if our providers participate with your particular plan, and the services you require are covered under your plan.  
  • Aetna
  • Blue Cross and Blue Shield of Rochester
  • Blue Cross and Blue Shield of WNY
  • Cigna
  • Empire Blue Cross and Blue Shield  (call member services)
  • Fidelis Care
  • Lifetime Benefit Solutions
  • Martins Point
  • Monroe Plan/Blue Choice Option
  • Multiplan/PCHS
  • MVP Healthcare
  • MVP Option
  • NYS Medicaid
  • Tricare (some plans, but not all)  www.tricare/mil
  • United Health Care                        

Our providers admit to, but are not employed by, Golisano Children's Hospital at URMC and Rochester Regional Health Service (RGHS).  

We utilize ACM and URMC labs for patient testing and to process specimens.  Please make us aware of any conflicts with your insurance coverage.  

While there are numerous insurance plans available to our patients, we encourage you to check your plan's list of participating providers to confirm we are participating with your plan. If we are not participating with your health plan, you will be charged "out of network" fees by your plan.  Please let our staff know if our providers are "out-of-network" of your insurance plan.

To review our practice fee schedule, please contact our Billing Office at 585-377-8105.  Be advised that the fee schedule is an estimate of your visit and may not include absent or unforeseen circumstantial charges.  

Frequently Asked Questions about health care costs

Thank you for entrusting your child's care to Penfield Pediatrics.  We are committed to providing you with excellent service in all aspects of your care, including answering your questions about your health care costs.  With more patients moving to high deductible and co-pay insurance plans, we find many patients have questions about medical expenses. We are providing this tip sheet to make you aware of some of the ways you can better understand your potential expenses while receiving care at Penfield Pediatrics.  

* Become aware of your insurance plan's "network tiers"
Today, many insurance plans sort providers into "in-network" and "out-of-network" tiers.  Typically "in-network" care is less expensive than "out-of-network" care.  Before you receive care, it's a good idea to contact your insurance company to help you understand how your health care provider's status in a particular tier may affect your healthcare costs.  

* Separate charges for some services
Autism, developmental, vision and hearing screening have always been important components of your child's wellness checks.  They are recommended by the American Academy of Pediatrics and are necessary to provide quality healthcare and to complete school/camp forms.  Please be advised that some insurance plans may not cover these screenings in full and you may be billed for the additional expense.  

Likewise, our providers use screening tools for depression, anxiety and ADHD to assist with the diagnosis and treatment of your child. Please be advised that some insurance plans may not cover these screening tools in full which may result in an additional expense billed to you.

If your child should receive an additional diagnosis or treatment during a Well Child Visit, your insurance must be billed for that service.  Depending upon your particular health plan, this may result in a deductible or copayment assigned to you.  

* Referrals and insurance plans
When your primary care physician sends you to a specialist or arranges a procedure or test, we will provide you with the name and phone number of the specialist or facility that will perform the service so that you can ask them if they are an "in-network" provider or facility with your insurance plan.  

Penfield Pediatrics Billing and Credit Policy

Billing Questions

We will do all we can to answer your questions or help you with billing matters.
"Billing should never get in the way of good patient care".

If you have any billing questions, either contact our billing manager, Connie Montana, or send an E-mail message using the following link: