Payment is due when services are rendered.
We accept cash and checks, Mastercard and Visa. Prompt payment allows us to control costs. Outstanding accounts cost both of us time and money; therefore, all patients will be required to establish financial arrangements for payment of their account. If you make full payment at the time of your visit, we can provide you with a Time of Service Discount.
All new patients will be required to remit full payment to establish an account. As a courtesy, our practice will establish a reasonable monthly/weekly payment plan to accommodate your needs.
If we are In-Network for your benefit plan you are contractually obligated to pay your Co-Payment, Co-Insurance and/or deductible portions at the time of service.
As we stated above, the primary goal of our practice is to provide medical care and services to the children of our community. Since our practice also has financial obligations, which must be met, we ask that all patients arrange to pay for services in full on the day of each visit to our office.
Once your insurance has cleared, you may receive a bill for additional amounts based on your insurance carriers' determination of benefits. For your account to remain in good standing with our office you, need to remit payment within 30 days.
Retuned Checks for Insufficeint Funds (NSF): Our policy related to NSF checks is based on the fact that most people make honest mistakes when balancing their checkbooks. Therefore, we follow this procedure when we receive a check returned unpaid.
1) If this is the first check returned to our office unpaid, we will send notice that the check was returned with a request for payment to be made within ten (10) days. If paid in ten (10) days our office will charge a $3.00 fee in addition to the amount of the check. This $3.00 is the fee charged to our business by our bank. (This $3.00 fee is subject to change without notice, at any time, but shall not exceed the fee charged by our bank.)
2) If payment is not made within ten (10) days, our office will charge a $25.00 Returned Check Collection fee, this fee is inclusive of the above mentioned $3.00 charge. This $25.00 Returned Check Collection fee may be changed at anytime, without prior notice, but shall not exceed the maximum allowable under State law.
3) If this is a second returned check, the above procedure will be followed with the exception that our office reserves the right to charge the Returned Check Collection fee without an opportunity to pay just the $3.00 fee charged by our bank. Again this fee may be changed at anytime without prior notice, but shall not exceed the maximum allowable under State Law.
4) If this is a third returned check, the above procedures will be followed, your account will be placed on a "CASH ONLY" basis
5) Failure to maintain your account in good standing after 3 returned checks will result in termination of the patient/physician relationship.
1) Any future services will be on a "CASH ONLY" basis. Payment in full of all patient responsibility is expected prior to any services being rendered. An estimate based on a Level 3, Established Patient visit will be used if visit for Illness or Injury, an appropriate level office visit for the age of the patient shall be used for any well child care and shall include any immunization administration fees.
2) If your insurance plan is a deductible plan, instead of a co-payment plan, our office reserves the right to require a cash deposit equal to the deductible for each child. Any such deposit will be held on account for 12 months. This deposit will not earn any interest of any kind. At the end of 12 months if the account has remained in good standing, we will credit the deposit to future services, in lieu of payment, until funds are depleted. Alternatively, a written request for refund may be submitted at which time our office will refund any remaining balance within thirty (30) days. If the account does not remain in good standing, our office may require the deposit to remain on account until such time as the account has been in good standing for 12 consecutive months or the family notifies our office in writting that they wish to terminate the physician/patient relationship and will be seeking medical care from another physician. If the family terminates the relationship, then we will use our best efforts to issue a refund as timely as possible.
3) At any point if a "CASH ONLY" account is not paid in full at the time of service, our office shall use any deposited funds to cover the charges for the services rendered. Deposited funds will be required to be brought back to the required deductible level within 15 days. Failure to do so will result in the account being taken out of "Good Standing" status.
4) Any "CASH ONLY" account that does not maintain "Good Standing" can be dismissed from the practice and the physician/patient relationship terminated with thirty (30) days written notice.
Overpayments will be applied to oldest balances. Any credit balances will be refunded to the responsible party within 30 days of written request.
