P&A Medicine’s Financial Responsibility Policy
Thank you for choosing Pediatric & Adolescent Medicine. We are committed to providing excellent quality pediatric medical care to infants, children and teenagers in a safe and nurturing environment. As part of your relationship with Pediatric & Adolescent Medicine, a clear understanding of our financial policies is important. Your health insurance policy is a contract between you and the insurance company.
You are required to:
- Present the proper insurance card for your child/children at the time of service. You must bring a valid insurance card to every visit.
- Present a picture ID (driver’s license preferred) for verification of identity; if requested.
- Pay your co-pay at the time of service. Our office is required to collect your co-payment on the date of service.
- Make payment and assume responsibility for any charges your health insurance company does not pay for and indicates is your responsibility (i.e. co-insurance, policy deductibles, etc.).
- Pay your account balance in full within 10 days of receiving your statement of outstanding charges.
- You are responsible for knowing the benefits and provisions of your insurance plan. If you have any questions regarding your benefits, please contact your insurance carrier.
Verification of Insurance Coverage
We verify insurance coverage electronically at every office visit. If we are unable to verify active coverage, all fees for services will be due on the date of service. You must report any insurance changes to the office immediately.
Well Child Visits
Well Child Visits are generally exempt from copays. If your doctor provides management or treatment for a separate and specific problem at the Well Child Visit, there may be a copay or other charge. For example, if a new problem such as chronic headache or an injury/illness is identified, discussed in detail, and a treatment plan is made, this may trigger a copay or other charge as dictated by your insurance company. You are responsible for any copay or additional charge per your Explanation of Benefits.
Failure to pay your bill may result in dismissal from the practice. If you receive a dismissal letter you will no longer be able to schedule appointments, get medication refills or consider us to be your doctor.
Pediatric & Adolescent Medicine will not get involved in custodial, separation or financial disputes between parents of a child(ren) to whom we provide services. Please note that a court Divorce Decree or any other legal agreement is an agreement between the two divorcing parties and not between Pediatric & Adolescent Medicine and the parents.
Missed Appointment/ No Show Visits
Missed appointments, cancellations/rescheduling represent a cost to us, to you and other patients. We require at least a 24 hour notice for any cancellations or rescheduling of a previously scheduled appointment.
Pediatric & Adolescent Medicine charges a service charge of $25.00 for all returned checks.
P&A Medicine’s Notice regarding Billing for Routine Physicals
The Affordable Care Act ensures routine care is provided with no cost share to the patient. There are a select few number of plans that were “grandfathered in”, meaning that a copayment may still be required. Your insurance company will be able to inform you if your plan requires a copayment for routine physicals. Our practice does not determine what your insurance plan considers to be covered under a routine physical.
At your child’s well visit/routine physical exam, there are many topics that need to be discussed regarding your child’s overall physical and mental wellbeing based on guidelines set forth by the American Academy of Pediatrics. There is a lot to discuss during a limited amount of time including nutrition, growth & development, schooling and vaccinations to name just a few. It is our job to identify and address any concerning issues and bring them to your attention if the caregiver is not currently aware.
During the course of a routine physical examination, you and your provider may discuss a new health problem or other diagnosis at your visit which will require us to bill your insurance separately for these services. As a result, an additional copayment or deductible amount may be incurred. Our goal is to strive to address the issue at this visit and reduce the likelihood that an additional visit would be needed – thereby saving the patient and their caregivers inconvenience, time and expense. However, due to time constraints, your provider may be unable to fully address these important additional issues and you may be asked to schedule a follow up appointment in the near future so that we can deliver the best care possible for your child.
Here are a few examples:
- A 6-year old is seen for their routine physical. During the visit the provider is informed that the patient has been having ear pain. After an examination the provider determines that the patient has an ear infection and prescribes antibiotics. The provider will bill for the routine physical and an ADDITIONAL charge to your insurance for treatment of the ear infection.
- An 11-year old with a diagnosis of ADHD (or any chronic condition) is seen for their routine physical. This patient is due for a recheck of ADHD which should be occurring every 3-4 months. Specific issues related to ADHD, not ordinarily part of the routine physical, are addressed and questionnaire(s) are reviewed. Additional discussion about medication management is addressed. The provider will bill for the routine physical and an ADDITIONAL charge to your insurance for ADHD management.
- A 17-year old is seen for their routine physical. The patient discusses recent anxiety with the provider. The provider gives advice on how to cope as well as refers the patient to a behavioral specialist. The provider will bill for the routine physical and an ADDITIONAL charge to your insurance for anxiety management.
- A 13-year old is seen for their routine physical. This patient has multiple concerns about school, knee pain and behavioral issues that require an additional 10-15 minutes outside of the normal visit time. Rather than creating a second appointment on another day to address these separate issues, they are addressed at the routine physical. The provider will bill for the routine physical and an ADDITIONAL charge to your insurance for the new concerns.
- A 16-year old is seen for their routine physical. The provider notices that the patient has had significant weight loss since their last appointment and determines that a workup is needed to address this issue. The provider will bill for the routine physical and an ADDITIONAL charge to your insurance for the weight loss workup.
VISION AND HEARING SCREENS
Pediatric & Adolescent Medicine complies with the American Academy of Pediatrics guidelines by routinely screening your child’s vision and hearing. There are a select number of insurance companies that do not consider this part of the routine physical and may apply this towards your deductible or assess a copayment, which may result in a bill from our office.
BEHAVIORAL ASSESSMENTS AND DEVELOPMENTAL SCREENINGS
Pediatric & Adolescent Medicine complies with the American Academy of Pediatrics guidelines by screening for behavioral and developmental health problems at all routine physicals. These screening questionnaires are covered by most insurances, however there are some insurances that do not fully cover them. As a result, your insurance may apply these screenings toward your deductible or assess a copayment, which may result in a bill from our office.