Please read all of the agreements below and initial on your sign in sheet that you have read and agree to them. If you would like a copy of any of these policies they are available on request.
PERMISSION TO TREAT
As the parent/guardian of the child specified. I give WingHaven Pediatrics, LLC permission to treat and/or immunize my child in the event that I am unable to accompany him or her to the office. I understand that in all situations the doctors prefer to have a parent present to obtain a medical history, and to give permission for treatment or vaccinations.
WingHaven Pediatrics Financial Policy:
Due to frequent changes in health insurance coverage, we require that you provide proof of insurance coverage at each visit. If you do not have insurance, are unable to provide proof of insurance coverage, or are on a plan in which we do not participate, full payment is required at the time of your child's visit.
All co-payments are due at the time of service. These fees cannot be waived. All co-pays not collected at the time of service will incur a $10.00 billing fee. Please be aware that some services provided may be non-covered services and not reimbursable by your insurance. You are personally responsible for these services. For your convenience we accept cash, check, debit card, MasterCard/Visa and Discover.
If we are a participating provider, we will file your insurance for each visit. Should there be a dispute with your insurance company, our billing department will attempt to resolve it for you. During this time, the balance may be transferred to patient responsibility. Please note that your insurance policy is a contract between you and your insurance company, therefore, your balance is your responsibility.
Payment plans must be set up for balances that cannot be paid in full. We ask that the balance be paid within 6 months. Failure to resolve any past due accounts. including check will result in referral to a collection agency. Any family whose account is forwarded to a collection agency will be dismissed from our practice.
As a courtesy to you, Winghaven Pediatrics will file your secondary insurance. This is done after payment is received from your primary insurance. WingHaven Pediatrics policy is to file the secondary insurance one time. If payment has not been received from your carrier within 60 days, the balance becomes immediately due and payable by the patient.
WingHaven Pediatrics sends statements to patients on a monthly basis. Payment in full is due upon receipt. Regular payments help keep our cost and your charges down. If you are unable to pay in full, please contact our office to make payment plan arrangements. If payment is not received within 30 days and our office is not contacted a $10.00 rebilling fee will be added to each statement.
WingHaven Pediatrics accepts payment by check, Mastercard / Visa and Discover
Your insurance plan is indicated on your statement. To help your claim more efficiently. Please call our office with any discrepancies or changes.
Please contact our billing office at (636) 516-5561 regarding any additional billing questions or concerns.
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