Insurance & Billing

Accepted Insurance Plans

We accept many different insurance plans including:

  • Aetna
  • Blue Cross Blue Shield
  • Cigna
  • Humana / Tricare
  • Harvard Pilgrim Healthcare
  • Tufts
  • Tufts Health RITogether
  • United Healthcare
  • United Healthcare Community Plan

We also accept various other commercial insurers. Please contact us for more info

Note: If you have out of state Blue Cross, Harvard Pilgrim, or United Health Rite Care or Tufts RI Together please make sure the primary care physician (PCP) listed on your child’s account is your doctor. The insurance company will not pay if your child’s doctor is not the PCP, and you will be responsible for the balance.

    East Greenwich Pediatrics DOES NOT accept the following health insurances: Blue Chip Direct Advance, United Health Compass, Tufts EPO, Allways Health with prefix “COM”, Neighborhood Health, and non-HMO Medicaid. We DO accept the Tufts and United Medicaid plans. If you have any questions about whether we accept your insurance please call and ask!

    Billing Questions

    Please note that your insurance may not cover the following (or it may go to your deductible):

    • Urine tests
    • Flu tests
    • Strep tests
    • Nebulizer treatments
    • Audio hearing test
    • Pediavision vision screening
    • Developmental screens
    • Health Questionnaires

    You are responsible for anything your insurance does not cover. Please know that you pediatrician only does testing and procedures that we feel are necessary for the care of your child!

    FAQ Insurance / Billing:

    Why am I getting a bill for a strep test from EGP and the lab?

    Your doctor will do a rapid strep test in the office to get a preliminary diagnosis. If the rapid test is negative and the doctor wants to make sure it is not strep throat, the strep test is sent to a lab for a more sensitive test.  This leads to 2 separate facilities doing a strep test.  If there are copays and deductibles associated with this test, they would be applied to both facilities, resulting in a bill from both EGP and a lab.  If you know you have a deductible and do not want the strep test sent out to the lab, please speak to your doctor.

    Am I getting charged twice for the flu test?

    No.  There are 2 parts to the flu test – A&B – we need to tell the insurance company that we tested for both parts. If we send 1 procedure code, the insurance company sends it back asking us which part we did, therefore, we send 2 procedure codes to tell them we did both parts A&B. 

    Why am I getting a bill from AHS for the nebulizer?

    AHS lets EGP keep on hand the nebulizer machines in our office as a courtesy so that you do not have to go to another place to get the neb machine. However, it is not EGP property.  It is the property of AHS.  Once a machine is given to a patient, AHS is notified so they can send the billing through your insurance. If there are any co-pays or deductibles associated with this, you would receive a bill from AHS and you should pay them directly.

    Why am I getting a bill from Miriam Hospital?
    EGP does not have a lab in our office.  If your doctor wants any testing done (ie urine culture, wound culture), it is sent to the Miriam Hospital lab and they do the testing. Depending on the testing and your insurance plan, there could be co-pays and deductibles associated with these labs. If you feel this bill is incorrect, please contact your insurance company and ask them how the labs were processed. Unfortunately, EGP is not much help with these bills as we did not do the billing and we do not have the information needed to give you an answer.
    In some cases, the diagnosis code needs to be changed. If this is the case, call Beth in billing at our office.  Have your bill from the hospital with you so that you can give her the information she needs from that bill. We will change the diagnosis code and ask the lab to have the claim reprocessed. 
    Why am I getting charged an additional $10?

    EGP would like you to pay your copay when you check in for a visit. If you do not pay your copay at that time, we will add a $10 charge to your child’s account.  If you are one of the few patients who have a copay with well visits, this does not apply.  We do not know which insurance companies are still charging copays for well visits. There are always exceptions, if you feel you have been charged in error, please contact the billing department. 

    I have a secondary insurance, why am I receiving a bill?
    If you have London Health or Primarily Care as your secondary insurance, they only cover deductibles. Anything considered a copay is not covered and is your responsibility. This could include strep tests, flu tests, inhalation treatments, and actual copays.
    If you have another type of secondary insurance and are receiving a bill, please call the billing office to make sure we have your correct insurance information.
    Can I pay my bill online?

    No.  Payment can be made by sending in a check/money order, filling out the credit card portion on the statement or by phone by calling the office (x4 for billing).

    Why am I getting a bill for a phone call?
    As of January 2021, insurance companies may no longer be paying for telephone calls you have made with our doctors and nurse practitioners. You will receive a billed for copays, deductibles or other amounts not covered by your insurance. If you have any questions about what your plan covers, please call your insurance for further details.
    Why am I getting a bill for a virtual visit?
    Virtual visits are billed the same way as an in-office visit. Any fees, co-pays or deductibles that you have with an in-office visit apply. If you have any questions about what your plan covers, please call your insurance for further details.

    Office Hours

    Office hours are Mon-Fri 8AM-4:30PM.

    Saturday and Sunday mornings for urgent visits by appointment.



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