Billing & Payments
Metropolitan Pediatrics wholeheartedly believes that all children and families should have equal access to care and opportunities to live a healthy life. We work with every family situation to ensure children receive the best care possible.
For more information, please see our Billing & Financial Policies.
Good Faith Estimates
Patients who don’t have insurance or who are not using insurance have the right to receive a “Good Faith Estimate” of how much their medical care will cost.
Your Rights Under the No Surprises Act
- You have the right to receive a Good Faith Estimate for the total expected cost of your visit. This includes any known related costs, such as routine immunizations, screenings, and labs. Estimates do not include unknown or unexpected costs. Charges for unforeseen services, such as labs, tests, x-rays, or same-day procedures will be added to your final bill.
- Healthcare providers are required to provide a Good Faith Estimate in writing at least one (1) business day before your scheduled appointment. You can also ask us or any healthcare provider for a Good Faith Estimate before you schedule an item or service.
- If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
We accept most major health plans, including Oregon Health Plan. Call (503) 466-1668 to check if we’re in-network with your particular plan.
In-Network Health Plans
- BlueCross BlueShield
- Coventry Health Care
- First Choice Health
- Health Net
- Managed HealthCare Northwest
- Moda Health
- Oregon Health Plan (OHP)
- Providence Health Assurance
- DMAP (Open Card)
- Providence Health Plans
- Regence (except Regence OHSU network & Regence Beacon)
I thought well-child visits were covered at 100%. Why am I getting a bill?
At Metropolitan Pediatrics, we do our best to address your child’s health needs during every visit. With well visits, this can be tricky. Here’s why:
During a well visit, insurance companies want providers to stick to preventive care. Addressing an illness or problem (like an ear infection or rash) or managing a previously diagnosed health problem (like asthma or ADHD) is not considered preventive care. If this happens, you might have extra costs.
“Can you also take a look at… ?”
Possibly. Tests and procedures to diagnose or treat health problems are not considered preventive, so you may get a bill for them later. Here are some examples of non-preventive care you could receive during a well visit that may have an additional cost:
- Discussing new symptoms
- Unplanned procedures
- Treatment or testing for new/existing conditions
- Medication management (e.g., ADHD, asthma)
Occasionally, you may see both a well visit and an office visit billed on the same day. This happens when you meet the requirements of both types of visits in a single visit (e.g., a checkup combined with problem-focused care, such as treating an ear infection or rash).
What care is included in a well-child visit?
We follow the AAP’s Bright Futures recommendations for pediatric preventive care, which include:
- Physical exam
- Developmental screening
- Hearing screen
- Vision screen
- Fluoride varnish
- Lead level
- Lipid panel screen
- STD/HIV screen
Some health plans do not cover screenings, even though they are the national standard of care. Call your insurance to check your benefits.