Patient Billing and Financial Policy

BRIER CREEK OFFICE

10208 CERNY STREET, SUITE 104
RALEIGH, NORTH CAROLINA 27617
FAX (919) 226-0663

OFFICE HOURS
Monday – Friday: 8:00 a.m. – 5:00 p.m.
Closed from 12:30 p.m. – 1:30 p.m. daily for lunch
Walk-in Clinic: BLUE RIDGE OFFICE ONLY
Saturday/Sunday/Holidays: BLUE RIDGE OFFICE ONLY

Welcome to Blue Ridge Pediatrics and thank you for choosing us for your child’s medical care. Our goal is to provide a medical home where the physician and parents are an active part of their child's care, to ensure that children stay healthy and reach their full potential physically, emotionally, academically and socially. We welcome you to our family and look forward to caring for your child!

BLUE RIDGE PEDIATRICS, LLP PATIENT OFFICE AND FINANCIAL POLICY

Please read this information carefully as it explains, in detail, the patient’s office and financial responsibilities of our practice. Any questions regarding this policy may be discussed with our office manager.

Current Information

As a patient at Blue Ridge Pediatrics, LLP, you are required to notify our staff of any changes in your patient information, such as insurance, benefits, employer, patient name, home address and/or contact numbers. You are required to present your current insurance card(s) at each appointment.

Professionalism

Parents and patients are asked to conduct themselves in a professional manner. This office does not tolerate profanity. Anyone displaying abusive behavior will be asked to leave the practice.

Walk-In Clinic

We offer a Walk-In clinic exclusively at the Blue Ridge location for established, sick patients only. The hours are Monday, Tuesday, Thursday, and Friday from 8:00am – 9:30am and on Wednesday from 9:00am – 10:30pm.

Office Visits

At the Blue Ridge location, we offer scheduled appointments between the hours of 7:30 a.m. and 6:00 p.m. on Monday, Tuesday, Thursday, Friday and 9:00 a.m. and 6:00 p.m. on Wednesday. At the Brier Creek location, we offer scheduled appointments between the hours of 8:15 a.m. and 4:30 p.m. on Monday, Tuesday, Thursday, Friday and 9:00 a.m. and 4:30 p.m. on Wednesday. We are available Saturdays from 8:00a.m.-12:00p.m. and Sundays from 9:00 a.m. – 12:00p.m. for sick appointments at our Blue Ridge location only. We are also available on Holidays for emergencies only. There are no weekend or holiday hours at our Brier Creek location and no advance appointments are scheduled on Saturdays, Sundays and Holidays.

Please consider your child under the care of the Blue Ridge Pediatrics team. It is important for you and your child to be seen by all our physicians at least one time. After you have met all of us, and as appointments permit, we will try to accommodate you if you request a certain physician for both well and sick childcare.

Patients are asked to sit either in the sick room or well room after they check in. Please do not sit in the well room if you are seeing a physician for a sick visit. Once patients are brought to the exam room, they are asked to remain in the room until the physician has completed their exam. Please refrain from standing in the halls. If your child has a rash, please advise the receptionist immediately upon check-in so we can escort you to the treatment room.

If you need a prescription refill, please let the physician know before your appointment is over.

If your appointment is canceled because of an emergency, you will be notified.

Self-referrals

It is important for your primary care physician to be aware of any specialists you/your child may be seeing. If you/your child has been seen by any specialists without a referral from our practice, please be sure to notify your physician. You may be asked to complete a records request form in order for our office to obtain any records from the specialist(s).

Procedures for calling after hours

1. If it is a life-threatening emergency, please call 911.
2. For other medical advice, call 919-782-0021 to reach our voicemail system. Press one (1) for emergencies and a physician will return your call within 15 minutes. Press two (2) if you can wait up to an hour for a call back from the physician.
3. When you leave a message, please be certain to speak slowly and clearly. Be sure to leave your name, patient’s name and age, and a telephone number at which you can be reached.

Forms

Please allow 5 – 7 business days for forms to be completed by a physician. Parents are asked to completely fill out their section(s) of the forms before dropping them off to be completed. There is a minimum charge of $25.00 to complete forms and letters if they are not completed at the time of the appointment.

Inclement Weather

In the chance of inclement weather, please visit our website at www.blueridgepediatrics.com and click on the link to abc11.com for updates and notifications on closings or delays.

Payment at Time of Service

If your insurance plan requires you to pay a co-payment, it will be collected at check-in. Patients who fail to bring their co-pay may be required to reschedule their non-urgent appointment. If you are a self-pay patient or your insurance information cannot be verified prior to your appointment, you will be required to pay in full at the time of service. If your insurance plan requires payment of an annual deductible and/or co-insurance i.e. (80/20 plans), payment will be calculated and due at checkout. We accept cash, personal checks and credit cards. Patient payment plans are also available, if needed, by contacting our billing office prior to your appointment at 919-741-4918.

Cell Phones

We ask that patients refrain from using their cell phones in our office.

Parental Financial Obligations

We are not responsible for mediation between parents. The parent that brings the child to the appointment is responsible for any balances and payments due on the account.

Claims Filing

As a courtesy to our patients, we file claims with your insurance company and also coordinate benefits with secondary payers. You will be responsible in the event the claim is disputed or unpaid.

Our office does not accept discount cards. Patients are expected to pay for their visit at the time of service.

Patient Billing and Collections

Patients that receive statements from our office are expected to remit payment in full upon receipt, unless previous payment arrangements were made with our billing office. If your account must be referred to an outside collection agency for non-payment, a fee equal to 25-30% of the outstanding balance will be added to your account to cover the expense incurred from the agency. The fee percentage varies based on the amount of the outstanding balance. Patients being sent to collections will receive a dismissal letter from the practice giving them 30 days for emergency care and to find another physician. If you receive a billing statement that you do not understand, please contact our billing office at 919-741-4918 for assistance so that the account can be resolved.

No-Shows

Patients that fail to come to their scheduled appointment and do not notify our office of the need to cancel the appointment will be charged a $30.00 no show fee. This charge will be the patient’s responsibility; insurance companies will not pay this charge. Please notify our office 24 hours in advance of a well-child visit and 1 hour in advance for a sickchild visit if you cannot keep your appointment. After you incur 3 no shows with in 1 year, you will be asked to leave the practice. Patients are required to arrive 15 minutes prior to their scheduled appointment time. If the patient arrives late it is up to the doctor’s discretion whether the patient can be seen or not. If not, you may be asked to reschedule the appointment.

Returned Checks and Fees

An amount of $30.00 will be charged for a returned check. Personal checks will no longer be accepted from patients that write two bad checks and payments will then need to be made in cash, credit card, or money order.

PATIENT BILLING AND FINANCIAL POLICY

As a courtesy, Blue Ridge Pediatrics, LLP will file a claim for all services to your insurance. Therefore, at
registration, you will be asked for your current insurance information and will be asked to sign a
form verifying the information. It is your responsibility to assure we have your most current insurance
information and to notify us of any changes.

It is also your responsibility as the guarantor to verify that Blue Ridge Pediatrics, LLP is a participating
provider with your insurance company and to be familiar with your plan benefits (i.e. deductibles,
co‐ payments, in and out of network costs).

To summarize, you will be responsible for a bill for the following reasons:

• The service is not a covered benefit
• Your insurance company requires you to pay deductibles
• Co‐payments and/or co‐insurance are required by your insurance company
• Missed Appointment/No Show Fees charged for missed appointments

For all patients who must pay their health care bills, we accept cash, check, American Express,
MasterCard, Visa and Discover.

Upon receipt of a billing notice showing your balance due, you are expected to make payment in full.
Please contact our office if you have any questions or need assistance with understanding your bill.

To ensure timely receipt of your account information, please contact us if there is a change to your
billing address.

The parent/guardian or authorized individual that brings the child to an appointment is responsible for
payment of the services rendered.

MISSED APPOINTMENT/NO SHOW POLICY

You may be charged a Missed Appointment/No Show Fee of $30.00 for a missed appointment.An
appointment is considered a Missed Appointment/No Show if:

• The patient is a no show/no call for a scheduled appointment.
• We do not receive a 24 hour notice for cancellation of all appointments other than a same day sick appointment
• We do not receive a 1 hour notice for cancellation of same day sick appointments.
• The patient arrives late for an appointment and the appointment has to be rescheduled for another time.
• For any reason, the patient is not seen by the doctor at their original scheduled appointment time.

Patients who miss or no show for a double appointment (bringing two children in at the same time)
may be restricted from scheduling double appointments in the future.

ANY and ALL accounts that have 3 missed appointments/no shows within the same calendar year may
be terminated from the practice.