Billing and Insurance Information

Billing and Insurances:

To speak with someone from our billing department directly at (301) 517-9712 or email inquiries to [email protected]. If you reach voicemail during business hours, please know our staff is either on the phone with an insurance company or assisting another family. Please leave a detailed voicemail or send us a detailed email so that we may assist you faster.

Insurances Accepted:

  • Aetna – HMO, PPO
  • Aetna Better Health (Medicaid MCO)
  • Amerigroup (Medicaid MCO)
  • Carefirst Administrators
  • Carefirst Blue Cross Blue Shield – HMO, PPO, FEP
  • Carefirst Community Plan (Medicaid MCO)
  • Cigna – HMO, PPO (GreatWest)
  • Coresource (Aetna and Cigna Network)
  • First Health Network (Coventry & Adventist Healthcare
  • Golden Rule
  • Humana Military
  • John Hopkins EHP
  • John Hopkins Family Health Plan
  • Maryland Medicaid (Red & White) REM
  • Maryland Physicians Care (MCO Medicaid)
  • Meritain Health
  • Priority Partners (MCO Medicaid)
  • United Healthcare Community Plan
  • United Healthcare – HMO, PPO,

If your insurance company does not appear on the list above, or you want to confirm participation with your insurance, please contact our office. We cannot guarantee payment from any insurance company. It is the policyholder’s responsibility to verify if the provider is in-network with their insurance. If we do not participate with your insurance, you may still join our practice; however, you will be required to pay fee-for-service at the time the services are rendered.

While this office will verify your insurance policy coverage prior to your appointment, we advise that you contact your insurance company for any concerns you may have. Please familiarize yourself with the specifics of your insurance policy including coverage benefits and limitations. Information provided to us is not a guarantee of payment, all benefits are subject to plan provisions by the insurance company. Should you receive or request a test or procedure that is not covered by your insurance plan, any unpaid charges will become “patient responsibility”.

Our billing staff is available Monday through Friday 8:15am-12:00pm & 1:00pm- 5:00pm, to discuss your account and any questions you may have. To reach the billing department directly please call (301) 517-9712. You may also reach them via email at [email protected]. If you send an email, please allow 24-48 hours for a response.

Proof of Insurance:

In some cases, patients may have more than one insurance policy which would be considered Primary and Secondary Insurance policies. There are several rules that indicate which policy is Primary and which is Secondary. The following are some of the rules that apply:

* Policyholder's date of birth.

* Policyholder's coverage date, and insurance company types.

* A coordination of benefits will need to be completed to ensure that the insurance pays adequately.

Please note that Medicaid will always be secondary to all commercial insurance plans/policies.

Policy & Insurance Terms:

Guarantor: Is the responsible person for all co-payments, deductibles, co-insurance, and unpaid charges on the patients' account. The guarantor is always the patient, unless the patient is a minor or an incapacitated adult. This person may be the policyholder in most cases.

Policyholder: Is the individual owner of the insurance policy and may or may not be the responsible Guarantor and in some cases is the patient.

Non-covered Services: a "non-covered" service may include services that are covered under the plan but are not reimbursed because of some contractual limitation for example, (a second well-child exams, when a plan covers only one per calendar year, pre-existing conditions, and certain diagnosis not covered by plan).


Financial Agreement between Gold Pediatrics LLC and the Guarantor:

In return for services provided by Gold Pediatrics LLC we expect payment, at the time the service is rendered. Our practice is a participant with many health insurance companies. We recommend that you verify our participation with your insurance plan as financial responsibility ultimately belongs to the Guarantor of each account.

Your insurance policy is a contract between you and your insurance company. It is your responsibility to know and understand the provisions of benefits and payment for services rendered at Gold Pediatrics LLC. Please be aware of any co-payments, deductibles and/or co-insurances due at time of services rendered.

Financial Responsibility:

The Guarantor for the child(ren)’s account is responsible for all co-payment, co-insurance, and deductible amounts. Additionally, the guarantor is responsible for all charges and supplies that are not covered by the insurance company. Payment will be collected at the time of service for any known account balance in addition to any co-payment amount. Acceptable forms of payment include credit card, cash, or check. Return checks are subject to the return check fee of $35: The account will be charged for this amount on top of the original amount of the bill. After one returned check, we will no longer accept personal checks on your account.

Co-payments, Deductible, and Co-insurance:

Co-payments, deductibles, and co-insurance amounts are a contractual agreement between the Guarantor and their insurance company. As these are contractual agreements, co-payments and deductibles are due at the time services are rendered. If you have a deductible, the following payment terms apply: $65 deductible deposit for office visit, and $85 for preventative care office visit, are due for each visit, and each child, until your deductible has been met.

Our office will attempt to verify your deductible balance prior to every visit. As with any verification the dollar amount quoted to us may not reflect your actual deductible balance. However, we will collect the deductible deposit, and/or co-payment amount based on the information provided to our office at the present time.

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