Billing & Insurance

Pediatric Neurosurgery Group, P.C. will file your insurance claim, but you are ultimately responsible for paying for services received in this office. Many of the services provided in this office are covered and paid by your insurance company. We gladly file the claims for you so that your do not have the additional worry and effort of dealing with this during a time of illness.

You are responsible for paying your co-payments at the time of the service. If you have Blue Cross Blue Shield Master Medical, you are responsible for payment in full at the time of the service. We will then transmit your insurance claim for you and the reimbursement check is sent directly to you.

If you have an HMO, your insurance plan requires that you present a valid referral form or an authorization number EACH time you come to see the specialist. If a referral form is required by your insurance, it must be completed in the following manner:

Referred To (Choose One):
Michael Cools, MD
Ros Whelan, MD 

Location: Provider Office

Facility Name: (When applicable)

Pediatric Neurosurgery Group, P.C.

A referral may authorize more than one visit and/or there may be a validation time period. The referral is considered NOT valid when one of the following occurs: the number of visits has been exhausted, or the expiration date has been reached. If your referral has a validation period and authorizes multiple dates of service, we will provide you with a copy of the referral form so that you are aware of the expiration date.

Unfortunately, not all services are paid by the insurance company. In cases where the service had not been paid, you will be personally responsible for the bill. Before we bill you, we will make sure that all of the information sent to the insurance company is accurate and clearly describes the services you received.
Recent Federal laws addressing all insurance companies require that we submit every claim to an insurance company accurately, reporting the exact services performed and the exact reason for performing them. We are no longer allowed to change this information just so the claim can be paid by the insurance company.
Our practice is committed to these new laws, and will submit all claims to all insurance companies in this manner.