Office/Financial Policies and Pre-Registration

It is our goal at Pediatric Healthcare to focus on our patient's needs. Please take a moment to review our financial policies and attached forms so that we can make your visits more efficient. Please print and complete the appropriate forms and present them to the receptionist upon arrival to each visit. In addition to these forms please bring your insurance card to each visit so that we can verify that the billing information in our computer system is correct. Please note that your insurance may require that you pay a co-payment. Pediatric Healthcare is contractually obligated to collect your COPAYMENT at the time of each visit. A $10.00 processing fee will be added to all unpaid co-payments. In an effort to better serve you, if you are transferring a child to our office from another practice please acquire all of the appropriate medical records and bring them with you to the first scheduled appointment.

CHECKS - Please note that if your check is deemed non-payable for insufficient funds a $10.00 processing fee will be added to your account. The bank will attempt to collect the non-payable balance one time. If the funds are still insufficient an additional $20.00 will be charged to you at that time with a total processing fee of $30.00 added to your account.

MEDICAL RECORDS - Please note that is takes five to seven days to process and release requested copies of medical records. If our physicians are referring your child to a specialist the records will be sent to that specialist at no charge. All other record requests will incur an administrative processing fee of $15.00 per request and a supply cost of $.25 per page. We require that you provide our office with a signed record release and the documents will be released upon receipt of the record release payment.

PHYSICAL EXAM FORMS - When your child has a physical exam you will be given a HEALTH FORM for your child that will include his/her immunization record. This form can be used in place of any school, camp, daycare, etc. health form. Please KEEP A COPY of this form for your records. This form is valid for ONE YEAR. We suggest that you make several copies of this form and attach one to each form or application that you must submit. There is an $8.00 SERVICE CHARGE any additional forms that you will need within the year. If you do need an additional school form please notify our office in advance so that we can prepare the documentation.

REFERRAL REQUESTS - Some insurances require that the member get approval from their primary care physician and subsequent referrals before seeing a specialist. This is usually indicated on your insurance card but when in doubt please call your insurance company. When requesting a referral from our office an advanced notification of 72 hours is required. This allows us time to verify and submit the necessary documentation. Please note that if you arrive to the specialist without the necessary authorization you may be asked to reschedule and/or pay for the visit. All new patients must be seen in our office before a referral can be made.

AFTER HOURS - For after hours urgent care or illness call our main office number and our answering service will forward your call to a nurse triage service. The nurse triage service will call you back, assess the problem and advise you on how you should proceed. The appropriate physician will be notified and will be aware of the problem.If the problem is not urgent please call our office the following day and speak with our office staff.