Policies

Financial/Insurance Policies

>Policy holder / parent / guardian / patient are solely responsible for:

*providing updated current insurance information prior to every visit and please present the front office staff with the current insurance card(s) so a copies can be obtained for our records along with a policy holder / parent / guardian / patient valid photo ID.

*informing the office if patient is covered under multiple insurances at any given time and please be sure to communicate which insurance is primary and secondary in order that the office submits claims appropriately and avoids any future billing and/or COB (Coordination of Benefits) issues.

>All copays, co-insurances, and deductibles set by the insurance contract are collected at check-in prior to the visit. Remaining charges if applicable after claim processing, will be collected upon receipt of the insurance’s evidence of benefits (EOB).

>If your Insurance plan does not approve or fully reimburse the office for medical services provided due to the following:

• Benefit Exclusions
• Coverage Limitations
• Lack of Authorization
• Deemed Not Medically Necessary
• Unforeseen retroactive insurance policy terminations/changes (except where liability is limited by contract or state/federal laws)

The policy holder / parent / guardian / patient is responsible for all fees not paid in full by the insurance carrier – including when certain problem-oriented issue/s is/are identified by the parent/patient and/or the provider relating to the patient’s overall wellbeing during what appears to be a “well” or even “sick” visit – that require/s further evaluation, , management, education and treatment (along with the requisite documentation and billing – according to industry standards).

>We Care Pediatrics will attempt to validate your insurance benefits at the time of service, however, if the front office staff is unable to confirm eligibility, the patient’s account will be assigned as a “self- pay” status and the office will request full payment before the end of the visit (the office will refund the amount paid by your insurance carrier pending the EOB).

>We Care Pediatrics will subject a payment of an additional $50 service fee for the following:

• Payments that require 3 attempts to contact the policy holder / parent / guardian / patient via phone and/or statements
• Failure to communicate with office within a timely manner (60 days after the first attempt of communication)

We Care Pediatrics reserves the right to provide the patient with a final statement and a letter informing that our office has voided the patient relationship after 30 days of dismissal.

>We Care Pediatrics reserves the right to place delinquent accounts with a collection agency after the office’s  efforts have been exhausted to communicate with the policy holder / parent / guardian / patient to obtain outstanding balance.  The policy holder / parent / guardian / patient at this point will be responsible for any collection costs in addition to the outstanding bill. The practice will use its discretion as to providing further treatment or asking patient to find another physician.

>The policy holder / parent / guardian is responsible for providing the office with the appropriate motor vehicle accident information and claim number at the time of the visit if your child is being seen for concerns related to a motor vehicle accident.

>Credit Card On File

We Care Pediatrics allows patients to make payments with cash or valid Visa/MasterCard credit cards.  The office utilizes a secure credit card system- Instamed- to keep a funded, non-expired credit card on file at all times given the office will automatically collects co-pays, deductibles and co-insurances as soon as the office receives the EOB from the insurance plan.

>Scheduling/Appointments

We Care Pediatrics reserves the right to re-schedule appointments if the most updated demographic information and medical insurance (i.e. insurance card/s) are not made available at every visit and/or if the expected payment is not received and/or a valid credit card is not allowed to be filed at the time of the visit.

> Appointments must be cancelled at minimum 24 hours prior to the visit- Allergy Test must be cancelled 48hours prior to scheduled procedure.

>Any missed appointments and/or appointments that are cancelled less than 24 hours prior to the scheduled appointment time will be subject to a $25 charge, if applicable. The patient can be assigned to a lower “tier” office “access category” that could result in the patient and family members being ineligible for appointments going forward and only be seen on a “walk-in -sameday” basis due to the risk of patient and family not showing up for scheduled appointments.

>We Care Pediatrics reserves the right to dismiss a patient / family from our practice if:

• the patient/family is unable to keep the scheduled appointments by missing a total of three (3) appointments
• the family or guardian of the patient is unable to control the patient and/or themselves or their other family members or charge’s behavior (risk to anyone and/or themselves) while in and/or around the office and office park’s grounds at any time
• conflict of interest with staff member at We Care Pediatrics
• non-compliance with the medical plan /treatment after receiving sufficient warnings by office staff of risks to the patient due to non-compliance
• Policy holder / parent / guardian / patient non-payment for services rendered after 3 attempts by office to receive payment

>Failure to keep follow-up appointments including the expected age appropriate “well” visits (at 2, 4, 6, 9, 12, 15, 18 months and the annual exams as of age two) and/or deviate from the recommended vaccine schedule promulgated by the American Academy of Pediatrics (AAP) https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Pages/Immunization-Schedule.aspx, could be construed as noncompliance with medical care and could be grounds for termination from the practice.

>After-hours appointments are defined as visits scheduled after 5:00pm, Saturdays and Federal Holidays. We Care Pediatrics reserves the right to implement an after-hours fee for those visits according to the insurance plan’s contract.

>We Care Pediatrics has the right to charge for any destruction / vandalism of the office property; wastage of vaccines (due to responsible Parent/Guardian/Patient deciding not to have the vaccine/s administered after initially giving verbal consent and/or after the vaccine/s being drawn up and Parent/Guardian/Patient physically interfering with the administration of the vaccine/s resulting in any spoiling or wasting the vaccine/s).

>To better provide services for the patient and effectively address concerns, please refrain from utilizing cellphones during your visit.

>Medical Records/Paperwork

*Please inform the front office at check in if any paperwork including:  notes / forms for school / excuse for patient / parents / guardians are needed at check to facilitate staff completing them as efficiently as possible.

*All school forms (physical, shot records) requests via phone must be done at least 48 hours in advance.

**Please allow the office at least 5 days from the time of requesting to completion of:

–Non-standardized /specialized letters of a personal and elective nature requiring a chart review including Family Medical Leave Forms, immigration or tax letters etc =$25.00 completion fee

—Medical Record Copy Fees:

#$1.00 fee for the first 25 pages copied and $0.25 per page copied thereafter

#electronic copies via an encrypted CD =$20.00 fee per chart

##receipt of the payment is required in full at the time of the request before the copying will be started.