Insurance and Billing Information
Sandhills Pediatrics will file claims with most insurance companies. We participate with Aetna commercial, Aetna-State Health Plan, BCBS-NC, First Carolina Care, Medcost, Cigna, Tricare Select (formerly Tricare Standard), NC Medicaid Direct/ NC Health Choice, and United Health Care.
Medicaid– we participate with NC Medicaid Direct, Wellcare, Carolina Complete Health/Centene and Tailored plans through Alliance and Trillium. See our info page. Effective 7/1/24 some Medicaid recipients were enrolled in Tailored Plans, which are regional plans so we are enrolled with Trillium and Alliance. If you have any questions about this please reach out to our billing dept.
Tricare Select–We are an out of network participating provider with Tricare Select (including Reserve Select and Retried Reserve). This means all well visits will be covered at 100%. Sick visit charges will be applied toward your out of network deductible and coinsurance. In accordance with insurance billing requirements, you may receive both a “well Check” and sick visit” charge for combined visits. This includes visits scheduled as well checks that involve additional complexity and time.
Tricare Prime: We are an out-of-network participating provider with Tricare Prime. Fortunately, we can see newborn babies insured by Tricare Prime for the first 90 days of life as if we were in network. Currently, Tricare Prime requires payment of 50% coinsurance on all visits including well visits and vaccines. Typically, Tricare Prime pays
100% of any charge for young infant visits because any deductible was met at delivery. Unfortunately, we cannot refer your child to a specialist if you have Tricare Prime. If your child requires subspecialist care, your child will need to see your Tricare Prime Care Manager for the necessary referral.
Some families who prefer seeing Sandhills Pediatrics have decided to change to Tricare Select because we cannot refer patients to a specialist with Prime. Many families have told us it is overall cheaper for them to have Select. Please speak with your Tricare
representatives/DEERS office about this if you have questions.
We have attempted to contract with Prime for years but have been unable to come to anagreement with their contractor. If you would like Sandhills Pediatrics to be a part of the Tricare Prime network, please call the 1 (800) number listed on your insurance card and
let the representative know you want Sandhills Pediatrics of NC to become part of Tricare Prime.
Champ VA: In our experience, ChampVA may take over one year to add a child to a benefit plan. Sandhills Pediatric is pleased to see children expected to be covered under ChampVA, but charges will need to be paid at the time of service. Sandhills Pediatrics will reimburse any charges when the child is successfully added to ChampVA and the claims have been paid.
If we do not participate with your insurance carrier, you will have the option to be self-pay, but you will be expected to pay the self-pay estimate in full at time of service.
Medicaid/Food assistance- NC now allows online application for benefits including Medicaid, NC Health Choice and TANF (Food stamps). Please complete the ePASS application and then you can complete the rest of the interview by phone if you wish. Online application for NC Medicaid/Food Stamps= ePASS
Contact information for local Dept of Social Service
Hoke County 910-878-1956
Moore County 910-947-2436
Montgomery County 910-576-6531
Richmond County 910-997-8480
Don’t qualify for NC Medicaid or NC Health Choice and no coverage through your employer? See Healthcare.gov