Financial Policy

Our goal is to provide and maintain a good physician-patient relationship. Letting you know in advance of our financial policy allows for a good flow of communication and enables us to achieve our goal. Please read each section carefully. If you have any questions, do not hesitate to ask a member of our staff.  

APPOINTMENTS

  • On arrival for an appointment, please sign in at the Front Desk. You should be prepared to present your insurance card at EVERY visit.
  •  We value the time we have set aside to see and treat your child. We do not double book appointments. If you are not able to keep an appointment, we require 24-hour advance notice. There is a charge of $50 for missed appointments if 24 hour notice has not been given.
  •  If you are late for your appointment (more than 15 minutes), we will do our best to accommodate you. However, on certain days it may be necessary to reschedule your appointment.
  • A surcharge of $25 is billed for all evening, weekend, and holiday visits. You will be responsible for any amount not covered by your insurance company.
  • We strive to minimize any wait time; however, emergencies do occur and will take priority over a scheduled visit. We appreciate your understanding.

INSURANCE PLANS

  • It is your responsibility to keep us updated with your correct insurance information. If the insurance company you designate is incorrect, you will be responsible for payment for the visit and to submit the charges to the correct plan for reimbursement.
  • It is your responsibility to understand your medical insurance plan especially with regard to items such as co-payments, coinsurance, covered services and participating laboratories. For example:
    a. You should know if your insurance requires a co-payment for annual physicals and, if so, how much it is.
    b. Not all plans cover annual healthy (well) physicals, sports physicals, or hearing and vision screenings. If these are not covered, you will be responsible for payment.
    c. Some insurance plans allow only one healthy physical every 365 days. If your plan follows this rule and you schedule more than one healthy physical in 365 days, you will be responsible for payment in full for the additional physical(s).
    d. For children younger than 2 years, there is a limit as to the number of allowable 
    well visits per year. If the number of visits is exceeded, your insurance company will not pay and you will be responsible for payment.
  •  If your insurance plan requires you to choose a primary care physician (PCP), make sure our name or phone number appears on your card. If your insurance company has not yet been informed that we are your primary care physician, you may be financially responsible for your current visit.
  • It is your responsibility to know if your insurance plan requires a written referral or authorization to see specialists, whether preauthorization is required prior to a procedure, and what services are covered.
  • We do not submit claims to secondary insurance plans. If you have secondary insurance, we will provide you with a receipt to submit for reimbursement. Your secondary insurance will send the reimbursement check directly to you. You are still responsible for any balance on your account with us.                                                                           

FINANCIAL RESPONSIBILITY

  • According to your insurance plan, you are responsible for any and all co-payments, deductibles, and coinsurances. You are also responsible for any services not covered by your insurance.
  •  Your co-payment is a contractual obligation with your insurance company and is due at the time of service. A $10 service fee will be charged in addition to your co-payment if we do not receive your co-payment by the end of the next business day.
  • If you do not have insurance, payment in full is expected at the time of service.
  • If our physicians do not participate in your insurance plan, payment in full is expected from you at the time of your office visit. We will supply you with a detailed receipt that you can submit to your insurance for reimbursement.
  • Patient balances are billed the first week of the month following our receipt of your insurance plan’s Explanation of Benefits. Your remittance is due within 10 business days of your receipt of a Statement from our office.
  • If previous arrangements have not been made with our billing office, any account balance outstanding longer than 60 days from the date of our first Statement will be considered delinquent and may be forwarded to a collection agency.
  • For scheduled appointments, past due balances must be paid prior to the visit.
  •  We accept cash, checks, Visa, and MasterCard credit and debit.
  • A $30 fee will be charged for any checks returned for insufficient funds, plus any bank fees incurred.  

FORMS                                                                                                            

  • Forms for school, camp, sports, etc. can be dropped off at the front desk or sent via fax to our office. Forms must indicate the patient's name, birth date, current address and phone number.
  • There is a $10 per form fee for school, camp, or sports forms. If only an immunization record is requested, the charge is $5.  Payment is due when the forms are dropped off. We will not begin processing forms until payment has been received. Insurance companies do not reimburse for form completion and we do not bill insurance for completing any forms.  
  • There is no charge for forms authorizing your child’s school or camp to administer medication to your child.
  •  While every effort will be made to complete forms as quickly as possible, please be aware that at certain times of the year we may receive hundreds of health forms in one week and each of these has to be reviewed by your physician before it is released.  Please do not wait until the last moment to drop off forms. We request a two week turnaround at all times.
  •  Completed forms will be held at the front desk for pick up by a parent/legal guardian. 

TRANSFER OF RECORDS

  • We charge $1 per page to copy or transfer medical records.  There is a minimum charge of $10 for records under 10 pages and a maximum charge of $100 for records over 100 pages.
  • Requests to transfer records must be made in writing and must include the patient’s full name, date of birth and current address and phone number.