IT IS IMPORTANT THAT YOU TAKE THE TIME TO REVIEW THIS POLICY.
• The parent or legal guardian of the child is financially responsible for this account.
• Co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company.
• All returned checks will be assessed a returned check fee of $30.
• Newborns must be added to your insurance policy before any claims will be paid. Most insurance companies require that you do this within thirty days after the baby is born.
• To ensure accuracy when billing your insurance company, we must have a current copy of your insurance card on file. Please bring your card to each visit. If we are unable to verify your insurance benefits, you will be required to pay at the time of service.
• Please notify us of any changes in your insurance coverage prior to your office visit. This will help prevent unforeseen delays the day of your visit.
• Please be aware that some and perhaps all services you receive may be non-covered or not considered reasonable and necessary by your insurer. You will be required to pay for these services at the time of your visit.
• Well-child checks, attention-deficit/hyperactivity disorder checks and other nonemergency appointments may be rescheduled if there are outstanding balances or if a co-payment is not made at the time of service.
• IT IS YOUR RESPONSIBILITY TO KNOW YOUR INSURANCE BENEFITS. We will do everything possible to assist you in dealing with your insurance company, but please remember they are a third party and you are ultimately responsible for your bill.
• If your insurance company has not responded within ninety days from the date the claim was filed, you will be responsible for payment of the bill. In the event the insurance company pays after you have paid, you may request a refund.