Insurance & Fees

Insurance & Fees

The following is the list of insurances with which we participate. This will be updated from time to time as needed:

  • Aetna Better Health
  • Aetna First Health
  • Aetna Commercial
  • Aetna TRS
  • Blue Advantage HMO Network
  • Blue Cross Blue Shield Blue Choice PPO
  • Blue Cross Blue Shield Health Select Point of Service
  • Blue Premier HMO Network
  • BSWQA Provider
  • CIGNA Commercial
  • Galaxy Health Network PPO
  • HealthSmart Preferred Care
  • Humana Choice
  • Humana Choice Care
  • Multiplan/PHCS/Beech Street – PPO
  • Scott & White Health Plan
  • Three Rivers Provider Network
  • Tricare Prime and Select
  • United Healthcare Commercial Plans

*Medicaid participation is optional and varies amongst Privia Medical Group providers – please verify participation prior to your visit.

Note: You should always check with your Privia Medical Group provider to verify plan and product coverage as this is not an exhaustive list, and plans change frequently.

Payment Options

We accept cash, Visa, Mastercard, Discover, American Express, and personal checks.


We encourage patients to keep a credit card on file to make the checkout process easier, faster, and more efficient. You will no longer receive statements from us, but you will continue to receive your Explanation of Benefits (EOB) from your insurance carrier once your claim has been processed, detailing the charges and payments made on your behalf.

At check-in we will:

  • scan the credit card of your choice, including your Flexible Spending Account (FSA) or Health Savings Account (HSA) card

After your insurance has paid their portion, we will:

  • notify you via email of the balance owed
  • charge the balance owed to your card on file
  • email a receipt for the charge

Your credit card information will always be fully protected by our off-site, card-processing partner Elavon, and not on our computers, as required by industry standards (Payment Card Industry Data Security Standard – PCI-DSS).


When an appointment is scheduled with one of our providers, we do our best to ensure that we have reserved the proper amount of time to provide the best quality of care to your child, and then address all of your questions and concerns. As such, we request a minimum of 24 hours’ notice if you need to cancel or reschedule an appointment. We can then reassign your appointment slot to another patient. When you fail to keep an appointment, not only does it tie up a spot in our schedule, but more importantly it means we are unable to see another sick child who might have really needed an office visit. As such, we have implemented the following fee schedule for appointments that are not kept or cancelled with at least 24 hours’ notice.

Preventative services (well child visits) are dedicated to the discussion and testing of wellness and disease prevention. Any discussion and associated testing for acute and/or chronic conditions may have separate charges and are usually not covered under preventative insurance benefits. Depending on your insurance company guidelines you may be billed for a copay, deductible or coinsurance for any non-preventative charges. It is your responsibility to know and understand your insurance benefits. If you have any questions, please ask a front desk team member.

Patients with divorced parents: The responsibility of payment for the treatment of minor children whose parents are divorced rests with the parent who seeks treatment. Any court ordered responsibility judgement must be determined by the individuals involved without the inclusion of the Grapevine Pediatric Clinic, PA.

No Shows
Missed Appointment $50
Missed Physical $100
Late Cancellation $50
Missed Pediatric Appointment $50
No-Show $50
Missed Procedure $200
New Patients Total Charge or Minimum $200 Deposit
Established Patients Total Charge or Minimum $150 Deposit
New Patients Total Charge or Minimum $200 Deposit
Established Patients Total Charge or Minimum $150 Deposit
Procedures Total Charge or Minimum $200 Deposit

Additional Resources

Avoiding Surprises in Your Medical Bills

Avoiding Surprises in Your Medical Bills (Spanish)

Understanding Healthcare Prices: A Consumer Guide

Understanding Healthcare Prices: A Consumer Guide (Spanish)

Planning For a Medical Procedure