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– We are in network with Tricare Select. We are out of network with Tricare Prime BUT we can see newborn babies insured by Tricare Prime for the first 90 days as if we were in network. Some families who prefer seeing Sandhills Peds have decided to change to Tricare Select because we cannot refer patients for testing with Prime. The cost share for well checkups and sick visits with Prime at our office is about 50% (except for newborns in their first 90 days, which is fully covered). Many families have told us it is overall cheaper for them to have Select- Please speak with your Tricare representative/ DEERS office about this if you have questions.
We are an Out of Network Participating Provider with Tricare Select (including Reserve Select and Retired Reserve) which means all Well visits will be covered at 100%, however sick visits could be applied towards your out of network Deductible and Cost Share (20%).
We have attempted to contract with Prime for years but have been unable to come to an agreement with their contractor. If you would like Sandhills Pediatrics to be 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.
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.
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