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.
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. We require payment of co-pays or deductibles at the time of service. Please contact the office to determine if we are providers for your managed care program.
Billing for Medical Services
Services charged to your account accurately reflect the level of service provided to your child. Per current industry standards (sometimes called “CPT”, or “Current Procedural Terminology”), the level of service is determined by evaluating the following components:
MEDICAL DECISION MAKING
COORDINATION OF CARE
NATURE OF PRESENTING PROBLEM
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).
We may bill for a “sick visit” on the same day as your “well visit”
If your child is evaluated for a potentially serious or complex illness during a scheduled well-child check, we may bill a “sick visit” in conjunction with the well visit. Your insurance will process the sick visit according to your plan guidelines, applying copay, coinsurance, and/or deductibles as applicable. You will be responsible for any amount your insurance plan deems your responsibility, and you will receive a bill for these additional services.
We do not routinely collect sick visit copays if you are only scheduled for a well child check. Any copay applied by your insurance carrier will be billed to you on your next statement.
Services included in a typical well visit
Health, developmental, and growth assessments, routine recommended labs and screening tests, a review of minor health concerns, sports physical and paperwork, review and catch-up of routine immunizations, anticipatory guidance.
Services not included in a typical well visit
Evaluation and management of new or existing complex health problems, review of multiple complex ongoing concerns, coordination of care among multiple specialists and ancillary health providers, addressing health concerns of siblings.
Our billing policies have been established to fulfill Current Procedural Terminology (CPT) guidelines. This is required by both Federal Law (for Medicare and Medicaid) and your insurance carrier (for commercial insurance). If you have any questions about your child’s bill, please contact our office.
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.
Repeated No-Shows for scheduled appointments are subject to a $25.00 fee per instance. We may also dismiss patients and families who repeatedly do not show for their scheduled appointments.
We encourage all patients to make an appointment, so we have adequate time to see everyone. If our schedule permits, we can ‘squeeze in’ a limited number of walk-in patients. Walk-ins will always be seen after scheduled patients, and we do not guarantee that walk-in patients can be seen.
Patients who ask to be seen by a physician without a scheduled appointment will be charged a $45.00 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.
Patients whose checks are returned by our bank will be charged a $15.00 fee.
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.
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.
Our price schedule is reviewed on an annual basis.
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.