Expert Care at a Single, Low Fee: Insurance & Access FAQs
Families pay a single out-of-pocket fee, in line with specialist visit rates, that covers the visit, X-rays, and casting. Our priority is making exceptional pediatric orthopedic care accessible to children, regardless of out-of-network benefits.
How can I access expert pediatric orthopedic care at a single, low fee?
Families pay a single out-of-pocket fee, in line with specialist visit rates, that covers the visit, X-rays, and casting. Our priority is to make exceptional pediatric orthopedic care accessible to all children, regardless of out-of-network benefits.
*Fee does not include durable medical equipment.
Will TPOC still work with my insurance?
Yes! We continue to work with all insurance plans, though now on an out-of-network basis. Families pay a single, low out-of-pocket fee for visits, X-rays, and casting. We handle all paperwork and will review your exact costs with you before your visit, so there are no surprises.
Our team is here to make the process smooth and ensure your child receives exceptional, personalized pediatric orthopedic care. If you have questions about your coverage, call 973-538-7700 and ask for Lisa, Linda, or Sanaa—they’ll guide you through your options.
What will I be responsible for paying?
Families pay a single out-of-pocket fee, in line with specialist visit rates, that covers the visit, X-rays, and casting. Our team will review your exact costs with you before your visit so you know what to expect.
We handle all paperwork, and finances never become a barrier to exceptional pediatric orthopedic care.
If you have questions, call our office and ask for Lisa, Linda, or Sanaa. They’ll review your situation one-on-one and make sure you fully understand what to expect.
Why is TPOC making this change?
Our primary goal is to provide excellent care for children. That’s why we went into this field. Insurance can be complicated and confusing, and we want to make it easier for families.
This new model allows us to work directly with insurance companies, minimize paperwork, and help families avoid surprises. It also gives us flexibility to expand access to exceptional pediatric orthopedic care for all children while continuing to provide a personalized, transparent experience for every family.
Ensuring children get the care they need remains our top priority.
What if I need help understanding my benefits?
We’re here to help. If you’re unsure about your coverage or just want more clarity, our team can:
- Contact your insurance company
- Review your benefits
- Explain how your costs are calculated
- Walk you through every step of the way
For personalized support, ask for Lisa, Linda, or Sanaa at 973-538-7700. They’ll review your plan one-on-one and make sure you understand exactly what to expect.
What if I receive an Explanation of Benefits (EOB)?
Your EOB is not a bill. You are only responsible for what you paid at the time of your visit, except in a few rare situations—your EOB does not reflect this. It is simply a summary showing what was billed to your insurance and what they covered. Insurance companies will not bill you.
What if I receive a call or statement from Affinity?
Affinity manages our billing services. You may receive statements or phone calls from them as part of our normal billing process. This is legitimate and directly related to your child’s visit with our office.
If you ever have questions about a communication you receive, please call our office at 973-538-7700 and we’ll gladly confirm it for you.
Do I need to submit my bill to my insurance company for reimbursement?
No — you do not need to submit anything. We handle submitting your visit directly to your insurance company. This is not for reimbursement to you, but it ensures your visit counts toward your out-of-network deductible.
Your focus should be on your child’s care — we take care of the paperwork for you.
What should I do if I receive an insurance check for an appointment or services?
If you receive a check from your insurance provider, please do not cash it. You’ll need to endorse the check to us and bring it to our office. You will sign the check as you normally would on the back, and below your signature, write: “Pay to the Order of The Pediatric Orthopedic Center”. We’ll handle it from there!
What if I have School Health Insurance?
Many schools offer student health insurance plans, which often cover visits, physical therapy, and preventive care if your child is injured at school.
If your child gets hurt at school or during a school event:
- Contact the school for the insurance paperwork
- Fill it out and submit it to us — we will handle submitting it with insurance
Enrolling in a school plan can help prevent unexpected out-of-network or emergency costs.