INSURANCE COVERAGE

You must provide your insurance card or proof of insurance at the time of each visit. If you do not have insurance, are unable to provide proof of insurance, or are on a plan in which we do not participate, full payment is required at the time of your visit.

It is very important that you become familiar with your insurance plans and understand its benefits. Certain plans have restrictions on certain services such as vision/hearing screening, immunizations and timing of well child exams. It is your responsibility to be aware and understand your plans restrictions and limitations. If you have any questions regarding your coverage, health benefits, health restrictions and payment determination then you need to contact your insurance company directly.

PAYMENT METHODS

All co-payments and deductibles are due at the time of service. These fees by law cannot be waived. For your convenience, we accept cash, checks, ATM cards, Visa and MasterCard.

INSURANCE

Children’s Wellness Center will bill insurance companies for which we are providers. You will be responsible for all co-pays and co-insurance at the time of services. Some of the services provided may be non-covered services and not paid by your insurance company. You are personally responsible for these services. You will also be responsible for all balances your insurance carrier does not pay within 90 days. You will receive a bill, which must be paid upon receipt.

If we are not a provider on your current plan or do not have proof of insurance than you will be responsible for the entire bill at the time of service. We will provide you with an encounter form at each visit so that you can file the claim with your insurance company.

RETURNED CHECKS

There will be a returned check fee of $25. If you have more than one returned check you may be asked to leave the Practice. Unpaid fees may be subject to referral to a collection agency.

MEDICAL RECORDS

Medical records are the property of Children’s Wellness Center. You can request copies of medical records in writing. We will provide copies of required medical records to specialists free of charge. All other copies will be charged per page to cover the costs of office staff and copying. We will provide you with your copies within 30 days of receiving your written request.

REFERRALS

If your insurance plan requires a referral prior to seeing a specialist or using a hospital service then we will need greater than 24 hours notice. We cannot issue a referral once services have been rendered. It is your responsibility to know your insurance company requirements.

MISSED APPOINTMENTS/ CANCELLING APPOINMENTS

Missed appointments seriously disrupt our practice. Therefore, please give us at least 24 hours notice when canceling an appointment. If you fail to show for an appointment you will be charged a $25.00 no show fee by our billing service. Cancellations with less than 24 hours notice and missed appointments will be charged. If you have three or more missed appointment you may be discharged from the practice.

PATIENTS WHO ARE NOT ACCOMPANIED BY A PARENT OR GUARDIAN

A parent or legal guardian must accompany all children/teens under the age of 18. The parent or guardian can designate another person to seek medical care for their minor by filling out a required form.

DELINQUENT ACCOUNTS

A payment can be arranged with our business office for past due amounts. Failure to pay or arrange payment of a past due amount may result in a referral to a collection agency. If this occurs then you will be responsible for all reasonable attorney fees, court costs and collection fees related to the delinquent account. If your account is referred to a collection agency for payment then you may be dismissed from our practice.