Office Policies and Procedures

PHONE SYSTEM: When you call our office, the phone system will be answered by our automated telephone system. Please listen carefully to the menu so that your call is directed to the appropriate department with little or no waiting time.

CELL PHONES: PLEASE TURN CELLULAR PHONES ON VIBRATE BEFORE ENTERING THE BUILDING.

HEALTH CHECKS: Try to schedule the health check appointment for your child in advance. This will enable us to accommodate your schedule and allow your child’s physician to spend ample time answering your questions and evaluating your child. We follow the American Academy of Pediatrics recommendations for frequent check-ups during infancy and yearly beginning at three years of age. We believe these visits are important to assess growth and development, as well as to offer advice regarding safety and emotional issues that are an integral part of a healthy childhood. Patients arriving later than 15 minutes after scheduled appointment time will need to reschedule. We understand that situations arise where you cannot keep an appointment. Kindly notify us 24 hours in advance if you are unable to keep an appointment.

WALK-INS: If you walk in without an appointment, you may be directed to the Urgent Care Facility or the Emergency Room if appropriate or we will try our best to “work you into the schedule by offering the next available appointment.

SICK VISITS: If your child is sick, please make an appointment as early in the day as possible. We work by appointment only; no walk-ins. Patients arriving later than 15 minutes after the scheduled appointment time will have the option to reschedule or wait for the next available appointment that day or referred to urgent care. Please be courteous and notify us as soon as possible if you will not be keeping your appointment, so that we may offer the appointment time to another sick child.

SAME DAY SICK and WELL Appointments: Most insurance policies cover Well Child Exam at 100% with no out of pocket expense to the family however, if your child is in the office for a well child exam and is actually sick or requires a prescription, our providers must document accurately which will cause your insurance company requiring your office co-pay for that visit.

NO SHOW / MISSED APPOINTMENTS: Missed appointments will be charged a $25 “No Show Fee,” These fees are not covered by your insurance. To avoid such fees please attend all scheduled appointments or call our appointment line at least 24 hours in advance to cancel the appointment. Please note that 3 “No Shows” within a calendar year will result in dismissal from the practice.

IMMUNIZATIONS: The Providers of this practice have made it policy to immunize all patients of this practice. If it is your choice not to immunize your child(ren), you will be asked to find a new pediatrician.

SATURDAY HOURS: We provide Saturday morning hours to see your sick child in the Fall/Winter Season. Please call our office as early as possible to schedule an appointment. Phones are answered beginning at 9am.

SIBLING POLICY: If you have another child with you today who is ill and is not originally scheduled to see the doctor, please immediately notify the front desk so that we may try to accommodate your child. DO NOT wait to inform us after you have entered the exam room.

CONDUCT CODE: Our practice fosters the environment of mutual respect among our staff and the families we serve. While we certainly understand sick children in addition to our daily stressors can make us irritable, we value our well-trained staff and very much want to keep them. As such we do not tolerate verbal abuse of them. Any episodes of such will result in dismissal from our practice.

NURSE PHONE CALLS: The nurse line receives a high volume of calls. For your convenience, there is a voice mail system on this line. Please leave your name and phone number and spell your child’s name and date of birth. One of our nurses will return your call as soon as possible. Morning calls are returned by 12:30pm, and afternoon calls by 5pm. Please note multiple messages regarding the same matter may delay response time.

PRESCRIPTION REFILLS: Please submit medication refill requests 72 hours in advance. Also note that Schedule II medications (ex. Includes most ADHD medications) require an encrypted keycode and cannot be refilled after office hours.

MEDICAL/IMMUNIZATION RECORDS: Please give a minimum of 72 hours notice for completion of school forms. This includes immunization records and physical forms. For a copy of the full chart, a medical record release form must be signed. Once we have the signed release form, there is a minimum of 72 hours before these records become available. If a second release is requested a $25 charge will apply. If you are a new patient or have changed pediatricians or have received immunizations from the Health Department, please check with our staff to make sure we have your child’s immunization records on file. If your child’s immunization records are not found or are not shown “up-to-date”, it is your responsibility to obtain the missing records. We highly recommend that you keep a personal copy of your child’s immunization records – we would be happy to make a copy for you!

INSURANCE: To properly file your insurance claim(s), we must obtain a current copy of your child’s insurance card every visit our office. This will help your insurance pay your claims in a timely manner and save you from being billed. In the event you do not provide proof-of-insurance, payment will be expected at the time of service. Further, if you provide us with incorrect insurance information, you will be responsible for the bill. If incorrect insurance information is given that requires a claim to be re-filed, there will be a $25 re-filing fee.

• It is your responsibility to contact your insurance company and find out whether our Doctors are participating physicians within your insurance plan. Some insurance carriers have a PPO, HMO, POS, or indemnity status, and it is very possible that our doctors may participate in only one of these areas, not in all.
• It is also your responsibility to read and understand your own insurance policy. Certain services and procedures may/may not be covered depending on your own insurance policy.
• The following circumstances may result in you being billed directly:
  • we are not participating physicians in your plan; insurance coverage is not in effect because of the date of visit
  • non-covered lab work is ordered/performed
  • or a non-covered service is performed or denied for the reason “not medically necessary”
• Co-payments are collected up front and are due at the time of service by the person bringing the patient for the visit. If you do not have your co-pay, there will be a $15 administrative fee added. If you have a deductible plan, $75 will be collected to go towards the visit.

PREMISSION TO TREAT: If someone other than the parent or guardian is bringing the patient, a notice stating approval of the visit must be signed by the parent/guardian and presented at check-in. Also, please ensure that you send payment for the visit.

REFERRALS: Referrals may be needed for specialists, emergency room visits, urgent care visits, etc. It is your responsibility to determine if your insurance requires a referral for health care visits outside of our office. If you do need a referral, please contact our office with an appointment date and time. We may need up to 72 hours to obtain a referral from your insurance.

LABS X-RAYS, OR OTHER AMBULATORY CARE SERVICES: If labs, x-rays, or other ambulatory care services are required beyond your office visit, it is your responsibility to know where your insurance company covers you to go for these services. Each insurance company contracts with different companies.

MEDICAL HOME: We work hard to provide comprehensive medical care and serve as your medical home. To that end, we expect that you contact our office FIRST before seeking specialty care or heading to Urgent Care.

PATIENT PORTAL: We are pleased to provide a Patient Portal in partnership with our electronic medical records provider, Office Practicum for the exclusive use of established patients. The Patient Portal is designed to enhance patient – physician communication. We strive to keep all information in your records correct and complete. If you identify any discrepancy in your records, please notify us immediately. Additionally, by using the Patient Portal, the user agrees to provide factual and correct information. The Patient Portal provides access to the following services: • Request appointments • Request prescription refills • Fill out growth and developmental surveys • View your medical records • Receive educational material • View current and past statements • Pay bills online • Send messages to clinical staff • Receive health maintenance reminders

Summary of fees for services that are not covered by insurance:

No Show Fee per Child: $25
Returned check: $25
Co-payment not paid at time of service: $15
School/sports/daycare/camp form (waived if presented at time of well visit): $10
Transfer Records Out (First time request free): $25 per patient, $50 max per family
Insurance Refiling Fee: $25

I have read and understand the above-mentioned policies, procedures, and notices.

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.