Billing

To ease any concerns about the financial part of your health care, we hope the following billing information will help you better understand the charges you will incur as a patient. The information listed below is specifically for services provided by The Pediatric Lung Center (PLC).

Outpatient Billing Information

  • Health Insurance

    If you have health insurance, you will sign a form during the registration process assigning benefits to The Pediatric Lung Center. When complete insurance billing information is provided, The PLC will submit a claim to your health insurance. The assignment of benefits authorizes your insurance company to send payments to The PLC as outlined according to your plan benefits.

    Health care insurance is intended to cover some, but not necessarily all, of the cost of your child's medical treatment. It is important to familiarize yourself with your specific policy regarding coverage and benefits. You may do so by contacting your Human Resource Department, reviewing your benefits booklet (plan summary) or by calling the phone number listed on your insurance identification card. You should be aware of any deductibles, coinsurance and copayments, as well as, non-covered services. It may also be beneficial to determine your yearly out of pocket expense. This may be extremely helpful if you have a flexible spending account and want to calculate what amount of money is put aside for the year.

  • Health Insurance Participation

    The PLC endeavors to contract (participate) with most of the major insurance carriers. With or without a contract, our business office will submit a claim to your insurance company. The PLC's business staff has many years of experience in working with insurance and will be happy to assist you with any questions or concerns you may have regarding your coverage or benefits. When you call to schedule an appointment, you will be asked about your current insurance coverage. Please be sure to give the scheduler all of the insurance information. The type of insurance, particularly Blue Cross Blue Shield products, may determine which office location your insurance considers services rendered as in network.

    See list below of The PLC's most recent participating insurances for Outpatient Services. To verify your insurance is participating on a specific date of service, please contact the business office as this list may change.

    Fairfax Office (East of Route 123):

    • Aetna (all products)
    • Amerigroup
    • Anthem Healthkeepers HMO
    • Anthem Healthkeepers Plus
    • Anthem of Virginia PPO
    • Cigna/GreatWest all products
    • District of Columbia Medicaid (fee for service) no HMO product
    • Kaiser HMO
    • Mamsi Life and Health (includes MDIPA and Optimum Choice)
    • Maryland Medicaid (fee for service) no HMO product
    • Medicaid of Virginia
    • One Net
    • TriCare Standard - certified providers
    • West Virginia Medicaid (fee for service) no HMO product

    Leesburg and Purcellville Offices (West of Route 123):

    • Aetna (all products)
    • Amerigroup
    • Anthem Healthkeepers HMO
    • Anthem Healthkeepers Plus
    • Anthem of Virginia PPO
    • Blue Cross Blue Shield Out of State
    • Carefirst PPO (No HMO)
    • Cigna/GreatWest all products
    • District of Columbia Medicaid (fee for service) no HMO product
    • Kaiser HMO
    • Mamsi Life and Health (includes MDIPA and Optimum Choice)
    • Maryland Medicaid (fee for service) no HMO product
    • Medicaid of Virginia
    • One Net
    • TriCare Standard - certified providers
    • West Virginia Medicaid (fee for service) no HMO product

Inpatient Billing Information

We hope to clarify the relationships of the physicians and other healthcare providers taking care of your child with the facility and your insurance company. Please note that your hospital bill may not include all charges for physician services. You will receive separate bills or statements from The Pediatric Lung Center, pediatric consultants and other ancillary services.

  • Health Insurance

    If you have health insurance, you will sign a form during the admission process assigning benefits to the hospital. This "assignment of benefits" also applies to the providers that see your child during your child's stay. When complete insurance billing information is provided, The PLC will submit a claim to your health insurance. The assignment of benefits authorizes your insurance company to send payments to The PLC as outlined according to your plan benefits.

    Health care insurance is intended to cover some, but not necessarily all, of the cost of your child's medical treatment. It is important to familiarize yourself with your specific policy regarding coverage and benefits. You may do so by contacting your Human Resource Department, reviewing your benefits booklet (plan summary) or by calling the phone number listed on your insurance identification card. You should be aware of any deductibles, coinsurance and copayments, as well as, non-covered services. It may also be beneficial to determine your yearly out of pocket expense. This may be extremely helpful if you have a flexible spending account and want to calculate what amount of money is put aside for the year.

  • Health Insurance Participation

    The PLC endeavors to contract (participate) with the same major carriers with which the Inova Health System has a contracted relationship. Since the dates for contracts with specific carriers may not coincide for both PLC and Inova, there are periods of time when the facilities will have a contract with a carrier and The PLC's contract will be in negotiation. Sometimes, there are carriers with which The PLC does not have a contract. With or without a contract, our business office will submit a claim to your insurance company. The PLC's business staff has many years of experience in working with insurance carriers. The business staff will follow-up on the status of your claim, and assist you with the appeal of the claim when necessary.

    See list below of The PLC's most recent participating insurances for Inpatient Pediatric Pulmonary Services. To verify if your insurance is participating on a specific date of service, please contact the business office as this list may change.

    • Aetna (all products)
    • Amerigroup
    • Anthem Healthkeepers HMO
    • Anthem Healthkeepers Plus
    • Anthem of Virginia PPO
    • Cigna/GreatWest all products
    • District of Columbia Medicaid (fee for service) no HMO product
    • Kaiser HMO
    • Mamsi Life and Health (includes MDIPA and Optimum Choice)
    • Maryland Medicaid (fee for service) no HMO product
    • Medicaid of Virginia
    • One Net
    • TriCare Standard - certified providers
    • West Virginia Medicaid (fee for service) no HMO product

    In order to streamline the process and ensure the appropriate authorizations for the hospital stay are obtained by the facility, please provide the facility with all of your current insurance information.

Your Financial Responsibility and Patient Billing

You will be asked when you schedule an appointment or at each visit if there has been any change in your insurance since your last visit. We ask this question to keep our records as accurate as possible. Having the appropriate information also allows us to properly file to your insurance company for payment of the services we provide to your child.

We are happy to answer any questions about your statement/bill for pediatric pulmonary, allergy or sleep services provided by The PLC.

Should you have any questions regarding a statement or letter, or need help with your bill, our billing department is available by calling the office at 703.289.1410 and selecting the appropriate billing option.