Minor Patients. In the case of divorced or separated parents, it is YOUR responsibility to have financial arrangements made according to the divorce decree before treatment begins.
Minor Patients. The adult accompanying a minor and the parents (or guardians) of the minor are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless services have been pre-authorized by the parents (or guardians) and payment has been made before or at the time of service in accordance with item number 3 above.
Minor Patients. The adult accompanying a minor and/or the parents (or guardians) are responsible for full payment at the time of service.
Minor Patients. The parent/guardian of a minor is responsible for payment of the minor’s account balance. Responsibility for payment of treatment of minor children, whose parents are divorced, rests with both parents. Any court-ordered responsibility judgment must be determined between the individuals involved, without the inclusion of Napa Centre.
Minor Patients. The parent or guardian accompanying the minor is responsible for full payment. In the case of divorced or separated parents, the parent accompanying the child is responsible for payment, without any exception. This office will not attempt to collect payment from a parent that is not present in the office at that visit. RETURNED CHECKS A $25.00 charge applies when a check is returned by the bank.
Minor Patients. For all services rendered to minor patients, we will look to the adult accompanying the patient for payment, even if that adult is not the financially responsible party. Missed/Canceled Appointments Appointments must be canceled at least 24 hours prior. Repeated missed or canceled appointments may result in limitations on your ability to schedule multiple children to be seen at once, or to schedule appointments during high volume times of service. Severe abuse of this policy may result in dismissal from the practice. Payment and Collection Policies Our goal is to provide care to your child even if you are having financial difficulties. There is no charge for speaking to the physician over the phone, and a payment plan for office visits can easily be set up. All children without insurance are eligible for free state-provided immunizations, which can be administered at the office. However, communication with the office is essential in order for Harmony Mills to continue this policy. In particular, if your insurance has a large deductible, this may not be visible to the office at the time of check-in, and you would only be billed for your regular co-pay at time of service. In this situation, you would receive a bill for the balance owed at a later time. Unless a prior arrangement with a written and signed agreement has been made with the practice manager, the insurance will be billed and then statements will be sent for any balance after your insurance plan pays its share. Payment is due upon receipt of this balance. If you believe there has been a billing error, please contact the office immediately. If you are unable to pay the entire balance, please contact the office immediately to set up a payment plan. Failure to respond to two statements requesting payment may trigger collections action. Should that become necessary a 30% fee or $35 charge, whichever is greater, will be assessed to your account and will result in dismissal from the practice. You will then be responsible for all fees due to the collection agency in addition to the balance owed. Laboratory Procedures All in-office lab work is sent to the local LabCorp facility for processing, along with the most recent insurance information we have on file for the patient. Harmony Xxxxx Pediatrics is not responsible for verifying if LabCorp accepts any particular insurance plan(s). In the event that procedures performed by the lab are not entirely covered by the insurance plan on file, you may receive a ...
Minor Patients. The parent or guardian accompanying the minor is responsible for full payment. If someone else is bringing the child we need to have your permission to discuss treatment and or approve of treatment needing to be done in the office that day by that adult. At that time we can also let you know the copay so the adult bringing them can be prepared. RETURNED CHECKS: A $25.00 charge applies when a check is returned by the bank. FINANCE CHARGES AND REBILL FEES A finance charge or rebill fee will be applied to all balances not paid within 60 days of the monthly billing date. A late charge of 1.5% on the balance then unpaid or a 3.00 fee for rebill (the higher of the two) will be assessed each month until paid. It is your responsibility to ensure your insurance company pays promptly so you can avoid finances charges. ANY BILLING DECREPANCIES MUST BE SETTLED WITHIN 30 DAYS OF THE FIRST BILLING DATE.
Minor Patients. For all services that are rendered to minor patients (under the age of 18), the parent and/or guardian of the patient is held financially responsible for payment and needs to be present for all visits. Information I hereby agree that the above enrollment information is correct, and I also agree that any changes to the enrollment information will be communicated to Healing Hearts Pediatrics as required to fulfill the medical and financial obligation for services rendered. Authorization I hereby request and consent that my medical records and non-written records be sent to my referring physicians, those physicians or ancillary facilities that I am referred to by the Healing Hearts Pediatrics P.L.C. and to my insurance company or its agents that may be authorizing treatment. I further understand that my medical records may contain sensitive information and hereby authorize the release of all confidential HIV related information, communicable diseases related information, drug and alcohol abuse/treatment information and mental health diagnosis/treatment information to the above. I also consent to release of immunization records and medication information to my child’s school and/or preschool which is deemed pertinent and necessary for my child’s enrollment and/or healthcare in the school district in which my child attends. Financial Authorization I hereby authorize payment directly to the attending physician for medical and/or surgical benefits, if any from the insurance carrier to Healing Hearts Pediatrics, P.L.C. If paying cash, I am responsible to pay at the time of service. Privacy Practices and Patient Rights and Responsibilities I have been presented with a copy of the Notice of Privacy Practices for the office of Healing Hearts Pediatrics, P.L.C. detailing how my information may be used and disclosed as permitted under federal and state law. I understand that the copy presented is a copy for my reading and viewing while in the office and if I request I will be given a copy of the Notice of Privacy Practices. I have been presented with a copy of the Patient Rights and Responsibilities and the Non- Compliance Reporting Form(s) for the office of Healing Hearts Pediatrics, P.L.C. and understand the process for reporting NonCompliance incidents. I understand that the copy presented is a copy for my reading and viewing while in the office and if I request I will be given a copy of the Patient Rights and Responsibilities and reporting forms for NonCompliance i...
Minor Patients. The adult accompanying the minor (under the age of 18) is responsible for full payment of the services provided. A parent or legal guardian MUST accompany the minor unless prior arrangements have been made.
Minor Patients. The adult accompanying the minor is responsible for the payment on the account. For unaccompanied minors, non-emergency treatment will be denied unless charges have been pre-paid. Initial
