Common use of Uninsured patients Clause in Contracts

Uninsured patients. For any patient without current active insurance, non-participating insurance plan or a lapse in coverage, we are happy to see your child for a visit according to the fee schedule listed below. We are happy to provide you with a detailed billing summary for submission to your insurance company if non-participation or lapse in coverage has deemed your child/ren a self-pay patient on the date of service. Effective May 8, 2012, all self-pay patients will be placed on a discounted sliding fee schedule. For the patient to receive the discounted sliding fee schedule rates, payment for services must be paid in full at time of service. If you have a question about the discounted sliding fee schedule, you may contact the office. NEWBORNS Congratulations on the birth of your newborn baby! Below is important information regarding insurance coverage. It is extremely important that you notify the insurance company immediately following the birth of your child to initiate the process of enrollment. Your visits during the first 30 days will be billed as a Self-Pay/Temporarily Held Claim while we are waiting for your insurance company to add the new baby to the existing policy. If our office is not able to verify insurance coverage with the insurance company after your child’s 31st day of life, then we must assume that your child is uninsured and the visit will become patient responsibility in addition to all previous visits on our Sliding Fee Schedule. Once you have obtained the new insurance information from the insurance carrier, please notify our billing department so that we may retroactively submit your claims for processing. Common Issues You Should be Aware of:

Uninsured patients. For any patient without current active insurance, non-participating insurance plan or a lapse in coverage, we are happy to see your child for a visit according to the fee schedule listed below. We are happy to provide you with a detailed billing summary for submission to your insurance company if non-participation or lapse in coverage has deemed your child/ren a self-pay patient on the date of service. Effective May 8, 201210/01/2022, all self-pay patients will be placed on a discounted sliding fee schedule. For the patient to receive the discounted sliding fee schedule rates, payment for services must be paid in full at time of service. If you have a question about the discounted sliding fee schedule, you may contact the office. NEWBORNS Congratulations on the birth of your newborn baby! Below is important information regarding insurance coverage. It is extremely important that you to notify the insurance company immediately following the birth of your child to initiate the process of enrollment. Your visits during the first 30 days will be billed as a Self-Pay/Temporarily Held Claim while we are waiting for your insurance company to add the new baby to the existing policy. If our office is not able to verify insurance coverage with the insurance company after your child’s 31st day of life, ,then we must assume that your child is uninsured and the visit will become patient responsibility in addition to all previous visits on our Sliding Fee Schedule. Once you have obtained the new insurance information from the insurance carrier, please notify our billing department so that we may retroactively submit your claims for processing. Common Issues You Should be Aware of:

Uninsured patients. For any patient without current active insurance, non-participating insurance plan or a lapse in coverage, we are happy to see your child for a visit according to the fee schedule listed below. We are happy to provide you with a detailed billing summary for submission to your insurance company if non-participation or lapse in coverage has deemed your child/ren a self-pay patient on the date of service. Effective May 8, 2012, all self-self pay patients will be placed on a discounted sliding fee schedule. For In order for the patient to receive the discounted sliding fee schedule rates, payment for services must be paid in full at time of service. If you have a question about the discounted sliding fee schedule, you may contact the office. NEWBORNS Congratulations on the birth of your newborn baby! Below is important information regarding insurance coverage. It is extremely important that you notify the insurance company immediately following the birth of your child to initiate the process of enrollment. Your visits during the first 30 days will be billed as a Self-Pay/Temporarily Held Claim while we are waiting for your insurance company to add the new baby to the existing policy. If our office is not able to verify insurance coverage with the insurance company after your child’s 31st day of life, then we must assume that your child is uninsured and the visit will become patient responsibility in addition to all previous visits on our Sliding Fee Schedule. Once you have obtained the new insurance information from the insurance carrier, please notify our billing department so that we may retroactively submit your claims for processing. Common Issues You Should be Aware of: