For the Parents of Our Patients

Sunshine Pediatrics is contracted with the following insurance companies and/or physician networks. A physician network is a group of physicians that a smaller insurance company may “rent” to provide care for their members. This means many smaller insurance companies may not be on this list, but the network they use might be. Always check your card to see which network they use. While we do file claims to your primary insurance, we do not file claims to secondary insurance plans. We will, however, provide you with the information necessary to file your own claims.

This list of insurance and networks can change at any time. We recommend that you call our billing department if you do not see your plan on this list: 803-980-7337 option 5.

Please keep in mind:

In order for us to file your medical claim accurately and within the timely filing requirements of your insurance plan, we request that you bring your insurance card at every visit. It is your responsibility to provide us with the most recent insurance card. If your insurance has changed, and you do not have the new insurance information, you will be asked to pay in full at the time of the visit. Once the information is received and the insurance has paid the claim in full, you will be refunded any portion you do not owe.

According to our contracts with the insurance companies and networks, we are required to collect your copay on the date of service. There is a $10 late fee for all copays and co-insurances not paid within 24 hours of the date of service or within an agreed upon time. Deductible responsibilities are also expected to be paid at the time of service, unless a funded HRA/HSA account is responsible. We will accept a $50 deposit toward your deductible, but if any balance is not paid within 30 days of being invoiced, the full deductible balance on future appointments will be due at the time of service. See our Financial Policies for more information.

We will make every effort to determine the benefits of your insurance plan prior to your visit, but it is up to you to know what your plan covers. We cannot guarantee that benefit information given to us is correct, and so the ultimate financial responsibility for any medical treatment is yours.

We recommend that you call your plan before your visit to find out what your benefits cover. You should ask specifically about wellness benefits, sick benefits, and immunization coverage. You should also ask if any deductibles, copays, and/or coinsurances apply to each of these benefit categories and see if there is a cap or maximum benefit amount that applies to each of these as well. For a glossary of commonly used insurance terms, please see our Financial Policies.

• Absolute Total Care

• Aetna (some networks are excluded)

• Ambetter

• BeechStreet network

• Blue Cross Blue Shield (some HIX policies are excluded)

• BlueChoice Health Plan

• BlueChoice Medicaid (Healthy Blue)

• Cigna

• CoreSource (uses multiple networks)

• Coventry HealthCare

• First Health/Coventry

• Humana and Humana Medicaid

• MedCost

• Medicaid (SC only)

• Molina and Molina Marketplace

• MultiPlan network

• PAI - Planned Administrators, Inc.

• PHCS

• Premier Health Plan (now SuperMed)

• SuperMed network

• Tricare (Out of Network Only)

• United Healthcare and their family of plans

• United Medical Resources/UMR

Our own providers are on call 24 hours a day, 7 days a week. We currently have no plans on using an outside nursing company to cover our after-hours calls. 

If you have an after-hours emergency that does not require an ambulance, please call our office at 803-980-7337. Please do not call for routine matters such as referrals, shot record requests, or an appointment time. Those calls should be made during Office Hours. The after-hours message you will hear will give you instructions on how to leave a voicemail message for our providers. Our phone system will page the on-call provider, who will then call you back within 30 minutes. If you do not hear from us within 30 minutes, please call back. More specific information can be found in our Office Policies.

During business hours, if you have a routine question about your child, you can call our nurse triage department for guidance and/or advice. Our triage staff follow the Barton Schmitt Pediatric Telephone Protocols, but our individual providers may have their own protocols that may apply to certain concerns. Any phone advice given is reviewed by your provider. Our triage nurse is available to answer questions on a wide range of topics, including whether a child needs to be brought in for a visit, or for advice on what to do for a gassy baby. 

For the vast majority of calls, the service is free. If however, the phone call leads to a prolonged conversation with the provider, or if a prescription and/or other orders must be sent in, there will be a charge billed to your insurance company.

Most important to know about our nurse advice staff is that we don’t just give the answer to your question without understanding the full picture of what is going on with your child. For example, you may call us for a Tylenol dose, but we would not be doing our job if we didn’t ask why, you needed it. Maybe your child shouldn’t get Tylenol, but a different medicine, or none at all. Maybe your child would be better served by a visit with one of our providers. Either way, we would not be practicing responsibly if we simply gave you the dosage and hung up. We take pride in providing you with care that is as comprehensive as possible over the phone.

Our Saturday hours are for urgent care only made by appointment. These hours are typically 9:00 am - 12 noon, but they may vary if there are not enough patients needing an appointment. During the summer, we are typically closed completely on Saturdays. 

We also do not allow the pick-up of prescriptions, school/daycare/camp forms, shot records, or other items, since we cannot be guaranteed to be open as late as you may need. Call first thing in the morning in order to get on the schedule to see the provider. Saturday charges will apply. For more information, please see our Office Policies.

In order to be able to have room to schedule an appointment for your sick child on the same day you call, we have certain restrictions that help us meet that goal. 

For example, we do not accept walk-ins. We ask that you call to make your appointment so that we may prepare for your visit. Also, please do not try to add on another child after you arrive. If you have a concern that a brother or sister is also sick, you must tell us on the phone when making your appointment. 

We will always try to make your appointment with your preferred provider, but if that provider is not there or already has too many patients, we may have to schedule you with one of our other providers. We do this to optimize our schedule so that we are utilizing our resources efficiently and wisely. We appreciate your understanding in this matter.

For more about our appointment policies, please see our Office Policies.

If you have a physical form (or any form) that needs to be filled out for a sports team, camp, extra-curricular activity, school, or any other reason, and you’ve had a routine well-child exam within the past 12 months, please bring the form (do not fax it) to our office for us to fill out. You may pick up the completed form after 48-72 business hours (not including Saturdays). There is currently no charge for this service. Please do not fax us your blank form because of quality concerns. 

Please note:

1. We cannot fill out the "physician" portion of any form until the "parent" portion is filled out first and included in what you give us, and 
2. Your account must be in good standing for us to process any paperwork, certifications, or forms.

If you would like a medical form or a certified vaccine record emailed to you, please fill out our online release: www.bit.ly/SunshineEmailRelease.

If you need a SC Certificate of Immunization for school, daycare, or for your records, please call our office at 803-980-7337 option 3, and leave a message with a request for a shot record, your child’s name and date of birth, your name and a phone number where we can reach you. We need at least 24-48 business hours’ notice for all shot record requests. Shot records may be picked up Monday through Friday during business hours. If you are coming for a well-child visit and immunizations, however, we can give you an updated shot record while you are here.

If you would like your shot record emailed to you, please fill out this online release: www.bit.ly/SunshineEmailRelease.

Note: Your account must be in good standing to receive a signed/certified immunization certificate. If not, we will simply provide you with an uncertified copy of your immunization record.