Contact us online now
Phone
Suite #100 Rockville, MD 20850
| Service | NCSF Package | A La Carte |
|---|---|---|
| Health (school/camp) forms* | Included | $50 per form packet |
| Patient letters of medical necessity/clearance/advocacy | Included | $50 per form |
| Prior authorizations (excluding appeals, see pricing below) | Included | $50 per call |
| Insurance claim appeals | Included | $25 per appeal |
| Prescription refills | Included | $20 per medication per refill |
| After hours calls to answering service | Included | $30 per call |
| Medical Records | Included | $50 per file |
| Billing summaries ** | Included | $5 per page |
| Account resolution with company HR and insurance | Included | $25 per 30 minutes |
| Immunization Record*** | Included | $10 per request |
We are no longer accepting opt out waivers. Submissions ended February 29, 2024 at 11:59pm. Due to the complexity of billing for both bundled and a la carte service option, those who choose to opt out of this fee are not eligible to opt into the bundled services until the following NCSF year. NCSF charges for families who have not opted out will begin March 1, 2024, and will be charged under the oldest child for the family.
The needs of families who are accessing our mental health department are significantly more than those only utilizing primary care services and therefore the following ADDITIONAL pricing and opportunity to pre-purchase bundled services applies.
| Service | Package | A la carte |
|---|---|---|
| Health forms | Included | $50 per form packet |
| Patient letters of medical necessity/clearance/advocacy | Included | $150 per letter |
| Prior authorizations (excluding appeals, see pricing below) | Included | $50 per episode |
| Prior authorizations with a peer-to-peer communication | Included | $250 per episode |
| Peer-to-peer collaboration (with another provider, therapist, school counselor, caretaker) | Included | $125 per episode (Therapist) $250 per episode (Psychiatrist) |
| Prescription refills without an office visit | Included | $50.00 per medication per refill |
If you are electing to opt out of the NCSF for primary care and/or mental health services this year, please click here to complete the waiver. You must complete this waiver for each child for whom you are waiving the bundled package. We must receive your opt out waiver no later than February 29, 2024 at 11:59pm. Due to the complexity of billing for both bundled and a la carte service option, those who choose to opt out of this fee are not eligible to opt into the bundled services until the following NCSF year. NCSF charges for families who have not opted out will begin March 1, 2024, and will be charged under the oldest child for the family.
Potomac Pediatrics will always be fully focused on helping your child and you to overcome any healthcare hurdle, with innovative, comprehensive and compassionate care.
