Our main focus is to provide excellent medical care to our patients. In order to do this, we must receive prompt payment. A financial policy has been developed for the following reasons:
- To meet the financial obligations of the practice
- To follow terms set forth in insurance contracts
- To help families understand their financial responsibilities for the services provided by us
Insurance Claims:
Medical Center Pediatrics will file claims with the insurance information that you provide. We accept most insurance plans; however, always check with your carrier to ensure that we participate. It is your responsibility to notify our office if there are insurance changes. If you fail to share insurance information that results in a claim rejection, you will be responsible. It is your responsibility to know your individual coverage.
MCP RETURNED CHECKS: All returned checks are assessed a $25 service fee, which is not billable to your insurance.
RESPONSIBLE PARTY: The parent/guardian who accompanies the child to the appointment is responsible for the payment that day. In cases of separation or divorce, both parents are responsible for any balances.
Newborns:
We realize that it may take some time for newborns to be added to an insurance policy. However, it is very important that you provide the insurance company with the information that they request in a timely manner. Failure to do so may result in delays of coverage and greater financial costs to you.
Copayments:
Copayments are expected to be paid at the time of service.
Account Balances:
If you have a deductible, coinsurance, or non-covered service, you will receive a bill in the mail. Payment within 30 days is appreciated. After 60 days, your account will be assessed a $25 fee for non-payment. After 90 days, we reserve the right to postpone treatment and also to dismiss your child from the practice for non-payment. We accept cash, personal checks, Visa, MasterCard, American Express, Discover, Debit Cards and Health Savings Account Cards. If your bill is sent to collections, you will be responsible for all charges incurred in this process. If there are financial hardships, we are happy to discuss payment plans.
Uninsured Patients:
We are happy to work with families that do not have insurance. Please request further information on our self-pay discounts.
No-Show Policy:
We strive to have available appointments to meet the needs of all of our patients. In order for us to provide complete care for your child, it is very important that every appointment is kept. Missed appointments negatively impact our ability to care for your child and others. A no-show appointment is classified as one where the appointment is canceled with less than 24 hours notice. A $25 no-show fee will be charged to your account with any missed appointment. If you have 3 no-show appointments, you will be dismissed from the practice.
Medical Records:
Should you require a copy of your child’s medical record, you may obtain it from the patient portal at no charge to you. Requests for MCP to copy records will be assessed a $25 fee.
My signature below indicates that I have read the above and agree to the financial policies set forth by Medical Center Pediatrics, PLLC. A copy of this policy may be provided to you at any time.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.