Patient FAQ: Insurance & Access at The Pediatric Orthopedic Center (TPOC)
Effective July 1, 2025
As we enter this exciting new chapter as an independent pediatric orthopedic specialty practice, we want to make it easy for families to understand how care at TPOC will continue—and how we’re working to make it accessible to everyone, no matter their insurance.
Out-of-Network? It’s not what you think – don’t worry!
We know the term “out-of-network” can sound intimidating, but in most cases, families end up paying the same — or even less — out-of-pocket for their child’s care.
Our top priority is ensuring every child receives expert, compassionate treatment without financial surprises.
Will TPOC still work with my insurance?
Yes! We continue to work with all insurance plans, though now on an out-of-network basis. Most families find that their costs are about the same—or even lower.
Our team will review your exact costs with you one-on-one before your visit, so there are no surprises. We work directly with insurance to minimize paperwork and make the process as smooth as possible, all while continuing to provide excellent, personalized care for your child.
If you have questions about your coverage, call us at 973-538-7700 and ask for Lisa, Linda, or Sanaa—they’ll guide you through the details and help you understand your options.
What will I be responsible for paying?
Most families pay about the same—or even less—than they did before. Our team will walk you through your exact costs before your visit so you know what to expect.
Your Explanation of Benefits (EOB) from your insurance provider is not a bill—it’s a summary showing what services were provided and how your insurance covered them. You are only responsible for what you paid at the time of your visit, except in rare cases, and your EOB does not reflect this.
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 sometimes confusing for families, and we want to make it easier for you.
This new model allows us to work directly with insurance companies, minimizing paperwork and helping families avoid surprises. It also gives us flexibility to expand access to care for all children while continuing to provide the highest-quality pediatric orthopedic treatment and 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.
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.