FULL PAYMENT OF AMOUNTS DUE MUST BE PAID AT TIME OF SERVICE. WE ACCEPT CASH, CHECKS, OR VISA/MASTERCARD/DISCOVER.
We are on many of the preferred provider (PPO) lists, and Regal HMO plans. Insurance coverage can be very complicated and we have excellent experienced people in our business office who can help you with any questions. We make every effort to make it as easy for you as possible. For most of the PPO insurance plans, we will file insurance claims for you. However, in order to bill your insurance company, we need timely, updated and correct insurance information. Keeping us informed of the correct information is your responsibility. You will be required to show your insurance card at every visit. Please be aware that some recommended services may not be covered by your insurance plan. It is your responsibility to know what type of insurance you have and understand the coverage it provides. Please understand that if you consent and accept any service recommended by your doctor, payment is ultimately your responsibility, regardless what coverage your insurance provides. Please do not hesitate to contact our billing department with any questions regarding your bill. All insurance payments or medical benefits should be assigned directly to your pediatrician.
Usual and Customary Rates
Our practice is committed to providing the best treatment for our patients and we charge what is usual and customary in our area. Any balance not paid by your insurance company for well child care, including immunizations, must be paid in full before the next scheduled appointment, unless a prior arrangement is made with the billing office.
Health Forms and Paperwork
We are glad to fill out all required health forms in a timely manner, usually within a few days. If an urgent situation requires a form to be filled out the same day, a $15 fee will be charged at the time of the service.
A complete medical record will be maintained on each patient. This will include notes of all services provided while you are under our care in addition to any medical records brought or mailed to our practice from a lab, hospital or another physician’s office. In the future, should you leave our practice, we will gladly forward a copy of your child’s immunization record and growth chart to another physician at no charge. However, fees will be charged for full medical records or other medical documents to be faxed or mailed. There is a charge of $0.25 per page, billed by an outside copy service, for records to be copied. If the chart is in storage, there is a one-time retrieval fee of $25. Charts are sent to storage after 2 to 3 years of inactivity or after records are sent to your new physician’s office.
Payment, Waiver Agreement
This Waiver Agreement states that you, the parent or the guardian of the patient, will be designated as financially responsible for all charges incurred for services rendered that are not covered by your primary insurance. These services include, but are not limited to immunizations, well-child appointments, sick visits, labs, screenings, and other requested or necessary medical procedures performed in this office. Co-payments and all patient balances are expected in full at the time of service. Patients not covered by insurance must pay in full for each visit at the time services are rendered. We accept cash, checks, Discover, MasterCard, and VISA. A service charge of $25 will be due for each returned check.