Billing and Payment Policy

As a policy holder of healthcare insurance it is your responsibility to be an informed consumer and inform us of any changes in your insurance coverage. If we are not provided with accurate and updated information, you may be responsible for payment in full for all services rendered. Pryor to you visit, it is your responsibility to verify our practice has a contract with your insurance carrier and that our physicians participate with your plan. It is expected that you have an understanding of what your policy covers, know your copayment amounts, deductible and coinsurance amounts. If your insurance carrier requires you to select a Primary Care Physician (PCP), it is also your responsibility to select our office prior to your visit. Any financial portion that is the “member’s responsibility” such as co-pay, deductible or a non-covered percentage will be collected at the time of service.

If for any reason it is not collected at the time of service, a billing fee will be added to your outstanding balance for each statement that is mailed.

Remember, your insurance coverage is a contract between you and your insurance company. Our practice is not responsible for services denied by your insurance company.

Our office accepts Mastercard and Visa., checks and cash. It is our billing policy to file all claims to those insurance carriers in which we are participating providers. Failure to make your payment at the time of the service will result in an additional $20 statement fee. Any outstanding balances are due within 30 days of the statement. The second and any subsequent statement will be assessed a $5 rebilling fee. All balances reaching 90 days will be sent to a collections agency. You will be then responsible for all collection fees and legal fees that our office incurs through the process utilized to collect the delinquent balance. If we do not participate in your insurance plan, you are responsible for full payment at the time of service.

Returned Check Policy

Check returned to us by the bank will be assessed a $25 returned check fee, in addition to the original amount of the check. You will have 10 days to clear the outstanding check. If you do not pay the check plus the return fee in the specified time, the check will be sent to a collection agency. In addition, we will only accept cash or credit card for any future visits.

Newborn Billing Policy

Newborns are usually covered on your insurance plan under a newborn allowance for the first 30 days from the date of birth. It is your responsibility to notify your insurance carrier of your newborn. We will hold the charges for 30 days to allow your insurance carrier to enroll your newborn. If we do not receive the new insurance information within the 30 days, we will have to bill you as a self-pay patient and you will be responsible for all services rendered.

Referrals Policy

At Pediatric Associates California we work hard to have specialists evaluate our patients in need. Referrals have become very hard to get approved and scheduled. For that reason once we schedule an appointment, the parents/legal guardian will be responsible to attend and or reschedule the appointment.

It will be the parent’s responsibility to give us updated contact and insurance information before we request approval and schedule an appointment with a specialist. Failure to do so might result in a failure to schedule an appointment.

We will not be responsible for missed appointments. The parents will be responsible to reschedule the appointment directly with the specialist. We will not reschedule or get approval from the insurance carrier for a missed appointment.