- The parent or legal guardian is responsible for payment at the time of the visit.
- For patients not accompanied by parents or legal guardian, written permission to treat the child is required before any treatment can be given.
- We do not accept patients who choose to deviate from or refuse the CDC’s recommended vaccination schedule.
- We accept VISA, MASTERCARD, cash or checks. Positive ID is required for all credit card or check payments. There is a $25 fee for all returned checks.
- Patients that pay in full at the time of service will receive a 25% discount. You may then file a claim directly with your insurance company.
- It is your responsibility to ascertain that your medical provider is a participating provider with your insurance company.
- If we are not in-network with your insurance company, you are responsible for filing the claim with your insurance company, and payment is due at the time of service.
- A current insurance card and positive identification are required at each visit.
- Failure to provide the required information will result in forfeiture of the scheduled appointment unless cash or credit card payment can be made for the total charges of the visit.
- You are responsible for verifying your insurance benefits and coverage prior to any visit so that you are not billed for unanticipated charges. Some insurance companies do not cover routine and non-routine services. Non-covered services will be billed directly to the patient. (Common exclusions: Vision Screens; After-Hour Phone Calls; Saturday surcharge of $40).
- All outstanding balances that have not been paid within 60 days will be billed to the patient and must be paid within 90 days from the date of service regardless of the insurance status.
- Unpaid patient balances older than 90 days will be turned over to our collection agency.
- We attempt to make reminder calls for well-visits, but it is ultimately your responsibility to remember appointments.
- Cancellations require 24-hour prior notice.
- Cancellations with less than 24-hour notice and missed appointments will be assessed a $25 fee.
- We schedule well checks at least one month ahead.
PLEASE CALL FOR APPOINTMENTS, WALK-INS NOT ACCEPTED.
After Hour Phone Calls
- Monday - Friday after 4:30 PM, weekends and holidays.
- There is a $35 charge for after-hour doctor consultations and a $25 charge for nurse calls provided by Triage 4 Pediatrics. We will bill you for this charge which you may then file with your insurance company. After-hours calls might or might not be covered under your policy.
HIPPA PRIVACY NOTICE
Nondiscrimination and Accessibility Requirements