1. Newborn Insurance Policy:
It is the guardian’s responsibility to add their newborn to an active insurance policy immediately after birth. Most insurance plans require newborns to be added within 30 days of delivery. Please note that our private practice does NOT offer a grace period (all insurances) for newborn coverage. If insurance is not active at the time of the visit, all charges will be the parent’s responsibility.

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2. Understanding Insurance Deductibles:
A deductible is the amount you must pay out-of-pocket before your insurance begins covering costs. Until it’s met, you will be responsible for the full cost of visits, labs, or other services. For example, if your deductible is $1,000, you are responsible for paying the first $1,000 of medical expenses. This amount is set by your insurance plan you have chosen. Balances from deductibles must be paid in full prior to the office visit.

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3. Account Balances:
Families are responsible for any outstanding balances associated with their child’s care. All balances must be paid in full prior to the start of any scheduled appointment. Please reach out to us in advance if you have any questions about your account.

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4. No-Show Policy:
We understand that emergencies may arise; however, missed appointments without prior notice impact our ability to serve all patients. Repeated missed appointments will result in changes to your scheduling privileges or we will ask that you consider establishing care with another pediatric provider better suited to your scheduling needs. Our goal is always to maintain a reliable and respectful partnership in your child’s care.

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5. Late Arrivals:
To ensure that each patient receives the care and attention they deserve, we are unable to accommodate late arrivals. If you arrive after your scheduled appointment time, you will be asked to reschedule for a later date. Arriving late places adds unnecessary stress on our providers and staff and disrupts the flow of care for other scheduled patients.

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6. Outside Labs:
Please note that any blood/lab work drawn at our facility and sent to an outside laboratory is billed directly by that laboratory. We are not affiliated with their billing process and do not manage or collect payment for these services. Parents/guardians are responsible for any charges incurred from the laboratory. We do not have access to what your insurance contracts will cover or reimburse for these services. For questions regarding lab bills, please contact the lab or insurance directly.

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7. Coordination of Benefits (COB):
If your child has more than one insurance plan, it is your responsibility to ensure COB is correctly set up with both carriers. Insurance companies are aware of overlapping coverage and require this information to process claims, this includes households that are separated. Our office cannot resolve COB issues. If claims are denied due to unverified COB, the balance will become the patient’s responsibility.

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8. Medicaid Eligibility Verification:
For patients with Medicaid, coverage must be active and visible on the Medicaid portal at the time of the visit. We are unable to accept verbal confirmation of eligibility from representatives over the phone. If active coverage cannot be verified through the portal, the visit will need to be rescheduled or be billed as self-pay.

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SIGNATURE: __________________________________ DATE: ___________________________________