Office Policies
Accompanying Adult Policy
The adult who accompanies the child to the physician’s office is responsible for presenting the child’s insurance card when checking in. The accompanying adult is responsible for notifying the staff of any insurance termination, expiration or policy changes. The accompanying adult is responsible for payment of any deductible and copayment/coinsurance at the time of service as determined by the contract with the child’s insurance carrier. If you plan on having a non-parent adult bring your child to the office, you may indicate so on the Consent to Accompany and Treat a Minor form. If you have not filed this form with us, kindly call us ahead of the visit so we can document properly. The non-parent adult will still be responsible for insurance information and copays if not provided by the parent ahead of time.
Patient Financial Responsibility
Your health insurance is based upon a contract between the insured party’s employer and the insurance company, or between the parent/guardian of the child, and the insurance company. The insurance company has the responsibility to provide supporting documentation (Plan Benefit Booklet and Enrollment Card(s)) to the insured. The insured party and any adult who benefits from the insurance plan, or whose child receives benefits from this plan, is responsible for the following information: the commencement and expiration date of the policy; the annual deductible, if applicable; the coverage of well visits and immunizations; if a provider, lab, imaging facility and/or hospital is contracted with the insurance company; the amount of your co-pay; pharmacy benefits. Many insurance companies have additional stipulations that may affect your coverage. The insured party is responsible for any amounts not covered by the insurer within 30 days of statement delivery. Late payments are subject to an additional late fee. If your insurance carrier denies any part of your claim, or if you or your physician elects to continue past your approved period, you will be responsible for your balance in full. We DO NOT bill secondary insurance.
Copay Policy
Some health insurance carriers require the patient to pay a copay for services rendered. The knowledge of a required copay is the responsibility of the insured. Copays are expected at the time services are rendered at each visit. The responsible party is the person bringing the child in for the visit. Thank you for your cooperation in this matter.
Well Visit with Sick Complaints
As you may know, there are specific regulations governing billing for healthcare services. As your child’s healthcare provider, we are required to follow these regulations when submitting claims to your insurance company. Unfortunately, insurance plans have varying rules regarding billing for sick and well visits. A well visit is an annual preventive exam designed to monitor your child’s growth and development. The screening, surveys and exam conducted during a well visit are meant for healthy children who show no symptoms of illness. If additional tests, services, or medications are provided that fall outside the scope of a well visit, extra charges may apply. While we aim to meet both your child’s well care and medical needs in one visit, please note that a co-pay may be required for additional sick care. If you prefer to have the well and sick care separated into two visits, please inform your provider prior to the exam.
Cancellation / No Show / Late Policy
To ensure we are able to meet the needs of our patients and to assure we have adequate openings for children needing appointments, Pack Pediatrics requires 24-hours advance notice to cancel a scheduled appointment. No shows and short notice (less than 24 hours) cancellations are subject to a $40.00 fee per missed appointment. This includes same day appointments that are canceled.
Pack Pediatrics also maintains a 10 minute late policy. If a patient arrives 10 or more minutes late for their scheduled appointment, they will be considered a no show and will be canceled. Further, Pack Pediatrics reserves the right to discharge a patient from their care if they have 3 total No Shows or Late Cancellations. The responsible adult will be notified in writing, via certified mail, if a child is discharged from our pediatric care.
Divorce/Separation Policy
A divorce decree is a legal agreement binding only upon two parties who made the agreement. Therefore, Pack Pediatrics is not a party to that contract. Both parents remain responsible for the child’s bills and that responsibility will be determined by the person signing this financial policy. Payments will still be collected and due at time of service by the accompanying adult. Please notify our practice of divorce or separation, and update any contact or mailing information. If your divorce or separation agreement includes restricted access to patient records, specific financial responsibility or other specification, please send that information in writing including any court orders restricting access. Disagreements that interfere with our ability to provide proper care to your child may result in a discharge from the practice.
Professionalism Policy
At Pack Pediatrics, we aim to provide quality care in a positive environment, with courtesy, respect and professionalism. Respect to the office staff, providers, other patients, and other family members is mandatory. Inappropriate language, rudeness, or disruptive behavior in the office, or non-compliance that negatively impacts the ability to provide care may be subject to discharge from the practice. If your child is discharged from our pediatric care, you will receive a written notice via certified mail.
Vaccine Policy
At Pack Pediatrics, we support vaccinating all children. Immunizations have greatly reduced the illness and death from infectious disease for children and the community. The safest and most efficient way to accomplish this amazing immunity for your child is to follow the CDC’s recommended immunization schedule. This schedule can be found on our website on the Current Patients page, or at https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescentage.html. Children that are undervaccinated without intent of catching up will not be allowed to transfer care to our practice in an effort to protect our most vulnerable patients. Some families desire to spread out immunizations. While this is not the preferred method, Pack Pediatrics will support an alternative schedule as set by the pediatrics team in our office. The disadvantages of our alternative schedule includes more frequent office visits, including a $35 Immunization Visit Fee per scheduled visit. Families will need to review the alternate schedule, and sign the agreement prior to the 2 month visit. The child must stay up to date on the alternate schedule.. Accompanying adults will be responsible for the Visit Fee at time of service. Pack Pediatrics reserves the right to discharge a child from our pediatric care for any variance from this schedule. Any patient not up to date on vaccinations by age 21 months and again at 51 months of age will be discharged from our pediatric care. This is to ensure a safe environment for all our patients.