Insurance Information

Kressly Pediatrics accepts the following insurance plans:

We do not accept Keystone First or Medical Assistance. This list may be expanded, based on patient interest and effort to become accredited. If your insurance is not on the list, please contact us with the information we would need to determine accreditation procedures. In the meantime, you might want to determine if you can self-pay at time of service and file a claim for reimbursement.

Always bring your insurance card to every appointment. Insurance companies and procedures change frequently, and our contracts with insurers require us to validate your insurance coverage each time we see you.

Please review our HIPAA Privacy Policy.

Company & Programs Provider ID
Independence Blue Cross/Blue Shield - most programs, including Personal Choice and Keystone Health Plan East. We do not accept Keystone First/Community Plans 2296430001 (KHPE)
Aetna - PPO only, We do NOT accept Aetna HMO plans 4201792
AmeriHealth - HMO programs 2296430001
AmeriHealth - PPO and Amerihealth Administrators
programs like CB Choice and Doylestown Hospital
1617189
Blue Cross - Highmark, Anthem, and out-of-state PPO
plans that participate in the national Premier Blue program
(look for the "suitcase" on your card that indicates portability)
1617189
Cigna - all programs 5288344005
United Healthcare - most programs except Community Programs/Keystone First 1210061
Private Healthcare Systems N/A

HMO Patient Procedures

If your insurance plan is an HMO or "capitated" program, you must contact your insurer and change your Primary Care Provider (PCP) to the ID of our office (listed above) before we can accept your medical records or make an appointment to provide care. Unlike traditional insurance plans, HMOs do not reimburse us for each office visit (other than your co-pay). Instead, we receive a small monthly stipend that covers all routine well and sick visits throughout the year, regardless of when or how often a patient is seen. Therefore, we must be listed as your PCP before we can assume responsibility for your child's care.

Many insurance plans, especially HMOs, have complicated rules regarding specialist visits and referrals. Even within the same insurance company, policies and procedures may vary from one employer to the next. As a result, it is impossible for Kressly Pediatrics to know the details of every patient’s insurance plan. If your plan requires referrals, please click here for our policies regarding referral preparation.

Special note for Keystone Health Plan East patients: Keystone only updates its PCP information on a monthly basis. If you need an appointment for a particular month, you must switch your PCP to our office prior to the 1st of that month. Otherwise you may need to wait until the following month for your change to become effective. If it is early in a month and you have not seen any other doctors that month, you may be able to back-date the change, but that doesn't always work. The safest course of action is to anticipate the change well before your child needs to be seen.

Don't have health insurance?

If you do not have health insurance for your child, click here to see if they may be eligbile for free or low cost health insurance. You may also want to review information regarding Pennsylvania's CHIP "Cover All Kids" program. For more information on the ACA Marketplace and your options, find accurate information on the American Academy of Pediatric's parent site. 

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