Business Information

Insurance

Financial Policy

Privacy Policy

Insurance

We will gladly file insurance for patients who participate in our managed care plans after we have verified their benefits. In order to file for you, we require proof of insurance prior to the appointment with the physician. Please contact the office to determine if we are providers for your managed care plan.

We must have your valid, current and verifiable insurance card prior to filing charges with your insurance company.

Copays/Co-Insurance

Most insurance companies require that we collect a copay/co-insurance from you each time that we provide services for your child.

If you need to return for the following reasons:

to bring back lab work,

for hearing and vision screening, or

for immunizations

on a day other than on the day of the original visit, you will be required, by your insurance company, to pay your copay/co-insurance both for the day of the original visit and on the day that you return to the office.

If for whatever reason, your insurance company does not ask for an additional co-pay/co-insurance, we will credit your account when we receive a complete explanation of benefits from them.

Plan Name

Aetna EPO
Aetna HMO/POS
Aetna PPO
BC/BS HMO/POS
BC/BS Open Access
BC/BS PPO
BC/BS Private
Beechstreet
Choice Care (Humana PPO)
Cigna EPO
Cigna HMO/POS
Cigna PPO
Coventry HMO/POS
Coventry PPO
Evolutions
First Health PPO
1st Medical Network
Galaxy PPO
Great West HMO/POS
Great West PPO
Humana HMO/POS
Life Well Health Partners EPO
Life Well Health Partners PPO
Multiplan
NovaNet
PHCS POS, PPO, EPO (now known as Multiplan)
PPO Next (now known as Viant)
Preferred Plan of Georgia
Southcare PPO (now known as First Health)
United Health Care - UHC HMO
UHC PPO
UHC EPO
UHC POS
Unicare
USA Managed Care


Hospital Affiliations

Scottish Rite Children's Medical Center

Northside Hospital

North Fulton Regional Hospital

Emory Johns Creek Hospital (Coming Soon)

Financial Policy

Welcome to Pediatric Physicians, PC

In order to better serve your children, Pediatric Physicians, PC would like for you to understand our financial policy.

Medical Services

It is the goal of PPPC that the services charged to your account accurately reflect the level of service provided to your child, as documented on the child's chart. Per current industry standards, the level of service is determined by evaluating the following components:

HISTORY
EXAMINATION
MEDICAL DECISION MAKING
COUNSELING
COORDINATION OF CARE
NATURE OF PRESENTING PROBLEM
TIME

Because we can not predict exactly what services will be provided for your child, we can not precisely tell you ahead of time how much your charges will be. For example: if a child comes for a re-check visit, but has new symptoms that are not related to the original diagnosis and the child is treated or diagnosed for those new symptoms, the charges for the re-check visit will reflect the higher level of service provided.

In addition, our charges reflect the primary reason for the visit (ie: well check-up vs. sick visit).

Payment

Payment is expected at the time of service. We accept cash, personal checks, credit cards (Visa and Mastercard), and check cards.

There is a 30% courtesy discount for all self-pay patients paying in full at time of service.

Appointments

In order to stay on schedule, we appreciate that you be on time for your appointment. Please call 24 hours in advance if you are unable to keep your appointment. Appointments not canceled within 24 hours are subject to an office visit charge. You may cancel an appointment by calling (770) 518-9277, 24 hours a day. Appointments more than 15 minutes late may need to be rescheduled.

Statements

Account statements are sent each month to all patients with balances that are patient responsible. Insurance billable items are not billed to you until your insurance company informs us that the charges are your responsibility. If you believe that we are billing you in error please let us know immediately.

Walk-Ins

Patients who are not having a medical emergency and ask to be seen by a physician without having a scheduled appointment will be charged a $10.00 walk-in fee.

Copies of Charge Tickets

If you would like an itemized copy of the services provided to you, please ask for one when you check-out. If at a later date you require copies from us, there will be a charge of $15.00 for each charge ticket.

Returned Checks

Patients whose checks are returned by our bank, will be charged a $15.00 fee.

Refunds

Refunds are issued to all patient accounts that have a credit balance of over $50.00. When possible, this is done at the beginning of each month.

Collections

Accounts with balances older than six months, which have not had payment on the oldest balance for that period of time, may be turned over to a collection agency.

Price Increases

Our price schedule is reviewed on an annual basis.

Professional Courtesy

We regret that due to the Healthcare Insurance Portability and Accountability Act (HIPAA), we are not able to offer this time honored consideration to colleagues and friends for whom we file insurance claims.


IF YOU FEEL THAT, BECAUSE OF YOUR PERSONAL CIRCUMSTANCES, YOU WILL NOT BE ABLE TO ABIDE BY THE POLICY STATED ABOVE, PLEASE TALK TO US ABOUT MAKING SPECIAL PAYMENT ARRANGEMENTS FOR YOUR FAMILY.

Thank you for choosing Pediatric Physicians, PC.

Privacy Policy

PEDIATRIC PHYSICIANS, PC

EFFECTIVE DATE APRIL 1, 2003
NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU. The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will elaborate on the meaning and provide more specific examples, if you request. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Payment. We may use and disclose medical information about you so that the treatment and services you receive at the practice may be billed to and payment may be collected from you, an insurance company or a third party. For example: we may disclose your record to an insurance company, so that we can get paid for treating you.

For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at the practice or the hospital. For example, we may disclose medical information about you to people outside the practice who may be involved in your medical care, such as family members, clergy or other persons that are part of your care.

For Health Care Operations. We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run the practice and ensure that all of our patients receive quality care. We may also disclose information to doctors, nurses, technicians, medical students, and other practice personnel for review and learning purposes. For example, we may review your record to assist our quality improvement efforts.

WHO WILL FOLLOW THIS NOTICE. This notice describes our practice's policies and procedures and that of any health care professional authorized to enter information into your medical chart, any member of a volunteer group which we allow to help you, as well as all employees, staff and other practice personnel.

POLICY REGARDING THE PROTECTION OF PERSONAL INFORMATION. We create a record of the care and services you receive at the practice. We need this record in order to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the practice, whether made by practice personnel or by your personal doctor. The law requires us to: make sure that medical information that identifies you is kept private; give you this notice of our legal duties and privacy practices with respect to medical information about you; and to follow the terms of the notice that is currently in effect. Other ways we may use or disclose your protected healthcare information include: appointment reminders; as required by law; for health-related benefits and services; to individuals involved in your care or payment for your care; research; to avert a serious threat to health or safety; and for treatment alternatives. Other uses and disclosures of your personal information could include disclosure to, or for: coroners, medical examiners and funeral directors; health oversight activities; inmates; law enforcement; lawsuits and disputes; military and veterans; national security and intelligence activities; organ and tissue donation; protective services for the President and others; public health risks; and worker's compensation.

NOTICE OF INDIVIDUAL RIGHTS

You have the following rights regarding medical information we maintain about you:

Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer.

Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by, or for, the practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer and you must provide a reason that supports your request. We may deny your request for an amendment.

Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. We may deny your request to inspect and copy in certain very limited circumstances.

Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You must make your request in writing and you must specify how or where you wish to be contacted.

Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the Privacy Officer.

CHANGES TO THIS NOTICE. We reserve the right to change this notice. We will post a copy of the current notice in the practice's waiting room.

COMPLAINTS. If you believe your privacy rights have been violated, you may file a complaint with the practice or with the Secretary of the Department of Health and Human Services. To file a complaint with the practice, contact Jose A. De Urioste, Business Manager/Privacy Officer at 770-518-9277. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION. Other uses and disclosures of medical information not covered by this notice or the laws that apply to use will be made only with your written authorization. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.

If you have any questions about this notice or would like to receive a more detailed explanation, please contact our Privacy Officer.


© The Sanders Law Firm, PC 2001, Notice, 3/31/03

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