Financial Policy

We are committed to providing the the best medical care possible. To do this, we must be paid for our services. The following statement explains our Financial Policy which we ask you to read carefully:

  • All patients should provide accurate and complete personal and insurance information prior to being seen by the doctor. This may mean that you will have to fill out forms and provide a copy of your insurance card before being seen. We advise that you bring your insurance card with you to each visit. You may also be asked to fill out a new information sheet periodically, so that we are able to keep our information current. Please help us by offering to update this information if you have moved, had a change in phone numbers or insurance plan.  Follow the link to download our information sheet if you would like to fill this out before coming. Download information form as a PDF.
  • All applicable co-pays and prior personal balances are due at the time of service.
  • We accept cash, checks or credit cards for payment.

 

Insurance Plans

We participate in many insurance plans. For some insurance plans we accept assigment of benefits, but in all cases we require that the guarantor (the person responsible for paying the bill) is personally responsible for paying whatever the insurance plan does not cover.

Every insurance plan offered through employers varies in what services are covered and under what conditions. We strongly recommend that you be familiar with your own plan benefits and the potential costs which might be incurred. Even though your plan might be a major plan, the details of coverage negotiated by your company for coverage of services may be very different than another company's plan. Also, companies frequently renegotiate their contracts with the insurance plan and change their plan benefits. Please make sure you familiarize yourself with these changes when they occur. It is our policy not to become involved in disputes between you and your insurance company about payment for services we have provided, other than to provide the insurance company with factual information as necessary.

 

Referrals

Some insurance plans require certain services to be approved before they are provided (pre-certification). We are happy to provide this service if we know it is needed. 

Some insurance plans require a referral from the primary physician (us) before seeing a specialist. If this is the case, we are happy to do this. Please make the appointment with the specialist, then call us with the name of the physician, date and time of the appointment, as well as the child's name and date of birth, parent's name and contact phone number. Please give us at least 2 business days before the appointment to facilitate the referral for you. It is our policy not to do retroactive referrals (trying to get payment for a visit with a specialist that has already happened).

 

Copayments

Some insurances require copayments for each visit.  These copays are to be collected at the time of the visit.  A $25 service fee will be assessed for all copayments not made on the date of the visit.

 

Missed Appointments

All appointments need to be cancelled 24 hours in advance. If you miss a scheduled appointment, we reserve the right to charge a $25 fee per missed appointment.

 

 

School forms or Copies of Immunization Records

If you need a school form completed or a copy of your child's immunization record, we are happy to fill this out at the time of a check-up/physical free of charge. If you need an additional copy completed by us before the next check-up, there will be a $10 fee.

We require 3 business days to complete school forms or generate an immunization record. If you need this done more quickly, we reserve the right to charge an additional fee.

When calling to request a school form or immunization record completed for your child, please call our main number and press option 4. Please leave a detailed message with all pertinent information including:

  • Your name and contact phone number (so we can contact you if we have questions and/or when your form is completed for pick up)
  • Child's name with spelling
  • Child's date of birth
  • What your request is (school form or immunization record, or both)
  • Whether you want us to contact you when the form is completed, mail the form, or fax it somewhere.

Please let us know the details for each one: if to mail, please provide us your address. If fax, please state the contact person and fax number where you want the form faxed.

 

Request for Transfer of Records

If you are moving or transferring to another physician, we are happy to provide a copy of your child's medical record to the receiving physician. You may download or pick up the form to request this. Once we have received the signed request, we will provide one copy to the physician you are transferring to, free of charge. Download Release of Medical Information form.

 

Financial policy PDF