Insurance & Fees

Middleton Pediatrics accepts the following insurance plans. The parent or legal guardian accompanying a child is responsible for any copays, deductibles, coinsurance, or fees not covered by insurance at the time of the appointment. It is the responsibility of the parent or legal guardian to verify that Middleton Pediatrics accepts your insurance before making an appointment.  Please contact your insurance company directly to determine if Middleton Pediatrics is in-network with your family’s plan.

*United Healthcare: We are NOT in-network with the M*Plus, CORE, NAVIGATE, COMPASS or NEIGHBORHOOD HEALTH PARTNER plans. Please call UHC to verify that we are in-network for your particular health plan. 

*Medicaid: Our office does NOT participate in any state-funded Medicaid plans; this includes BCBS and/or UHC Medicaid. 

For any plans not on the list, or if you have any questions, please contact our office by phone or by email at info@middletonpediatrics.com

Payment Options for Share Plans and Self-Pay Accounts

Self-Pay: We accept checks, cash, or credit cards. Payment is due when services are rendered and putting a credit card on file is required. You will be supplied with a price guide and vaccine schedule. Please ask about options for a self-pay discount, vaccines, and payment plans. 

Share Plans (Christian Care, Medi-Share, Liberty Health Share, and any others): It is required that a credit card be kept on file. You will be supplied with a price guide and vaccine schedule. We are happy to file the plan for reimbursement, however, payment for uncovered services will need to be settled within 30 days. We only offer a discount if no discount was given by the share plan. Please ask about options for vaccines and payment plans.

Insurance & Fees

The following is the list of insurances with which we participate. This will be updated from time to time as needed:

• Aetna
• Aetna Medicare Advantage
• Aetna Workers Comp
• American Specialty Health
• BCBS
• Beacon Health Options and Strategies
• Bright Health
• Cigna
• Cigna Behavioral health
• CorVel
• Disney Cruise Lines
• Employers Choice Network
• EX Comp
• Florida Blue: Select, HMO (not all HMO plans), NWB, PPACA, PPO, Traditional (NOT in-network with myBlue HMO plans and certain Marketplace plans as of 12/31/2023)
• Florida Hospital Care Advantage
• Health First Health Plans
• Heritage Summit
• Humana Choice Care PPO, Military, Military DME, MMA – No longer in-network as of 5/1/23
• Medicare
• Multiplan/PHCS Commercial
• Oscar
• Prime Health Services Commercial
• Provider Networks of America Commercial
• Sedgwick
• United Healthcare – No longer in-network with the UHC Marketplace plans (Marketplace only)

*Medicaid participation is optional and varies amongst Privia Medical Group providers – please verify participation prior to your visit.

Note: You should always check with your Privia Medical Group provider to verify plan and product coverage as this is not an exhaustive list, and plans change frequently.

Payment Options

We accept cash, Visa, Mastercard, Discover, American Express, and personal checks.

Card-on-File

We encourage patients to keep a credit card on file to make the checkout process easier, faster, and more efficient. You will no longer receive statements from us, but you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier once your claim has been processed, detailing the charges and payments made on your behalf.

At check-in we will:

• scan the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card

After your insurance has paid their portion, we will:

• notify you via email of the balance owed
• charge the balance owed to your card on file
• email a receipt for the charge

Your credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard – PCI-DSS).

Fees