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ABCD Pediatrics Financial Policy
In compliance with the Federal Consumer Protection Act and with certain provisions of the Texas Occupations Code Chapter 101, ABCD Pediatrics wishes to provide notice of its policies regarding the financial responsibilities associated with services rendered to you or to a member of your household/family.
(Effective July 1, 2015)
Thank you for choosing ABCD Pediatrics as your children’s health care provider. We appreciate your trust in us and the opportunity to carry out our mission statement, “To provide caring and informed attention to your children’s health and wellbeing as they grow and thrive into adulthood.”
Our office and physicians make a great effort to get insurance companies to pay their share of the cost of this care in a timely manner. However, due to the recent changes brought on by the Accountable Care Act, this is becoming more challenging. We have therefore implemented a new Financial Policy; please read and sign the policy acknowledgement form. If you have any questions, please ask to speak with the Office Manager.
Payment (co-payments or co-insurance) is due at the time of service. If your child/children have an outstanding balance, please make sure whoever accompanies the patient to the visit is prepared to pay it. We accept cash, check, or a credit/debit card to pay your account. A current credit card will be kept on file. Please give your credit card to the front office staff to scan into your account with this form. (Our software securely encrypts and stores your credit card information displaying the last 4 digits of your credit card number only. No employee or outside vendor will ever have access to your information.) The credit card will be encrypted and stored into your secured patient file, and used to cover your balance according to the terms of this policy.
Your insurance policy is a contract between you and your insurance company. This contract requires that we collect certain co-payment or prepayment amounts depending upon the type of insurance and insurance carrier at the time of service.
Regardless of your insurance status, when we determine that you owe a balance, we will mail a statement to the mailing address provided to us by you. If your address changes, you are responsible for notifying us. All statements are also available on our secure patient portal. Payment is due upon receipt of the statement.
Please contact our office as soon as possible after receipt of your statement should you have any questions, or should you wish to discuss the outstanding balance. Should you need it, we can help you set up a payment plan with a valid credit card. One-third (1/3) of the total balance is due the first day of the payment plan. The credit card used will automatically be charged for the second and remaining third owed on a monthly basis. We require payment plans to be arranged before your bill is 30 days old. In the event that your insurance pays us after that time, you will be reimbursed.
PROMPT PAY DISCOUNT
ABCD Pediatrics provides a prompt pay discount to those uninsured patients who pay for services at the time of service, thereby avoiding billing and collection costs by the practice. These discounts are set at 30% off the retail price of a Sick Office Visit and 50% off the retail price of a Preventative/Well Office Visit. Discounts do not apply to any services other than office services. Prompt pay discounts are not offered to insured patients where ABCD Pediatrics is contractually required to accept a specific fee schedule. However, we do everything we can to mitigate the expense of anyone who is underinsured.
SUBSEQUENT STATEMENTS AND UNPAID BALANCES
If your account remains unpaid, subsequent statements will be sent to the address we have on file. Although ABCD Pediatrics does not charge interest for amounts past due and left unpaid by insurance or patient, a $5.00 statement fee will be included for additional statements sent on unpaid balances.
When your balance is 90 days past due, your credit card will be charged for the full amount owed. If declined, your account will be frozen and turned over to an outside collection agency for non-payment. Collection agency balances require that we will no longer be able to provide healthcare services to your child/children. We continue to provide 30 days of emergent care to give you time to find another physician, and we work with you through any current treatment plans. In this event, the Guarantor of the account agrees to pay any fees incurred by the collection agency.
While we make a good faith effort to verify your coverage, we are not liable to guarantee that the information given to us by your insurance is correct. It is your responsibility to know what services may or may not be covered by your insurance. We encourage you to refer to your benefits manual if you have any questions about covered services and work with us to make sure that these services are provided at the most cost efficient manner.
I agree to provide ABCD Pediatrics with the most current and accurate insurance information as it applies to my child’s account. I will notify the office of any changes to insurance agree to the assignment of benefits. Finally, in the event that insurance information you provide delays payment, you will be asked to pay in full billed charges and seek reimbursement from your insurance provider directly. The insurance company gives us a very small window in which to file a claim, and incorrect insurance information usually delays this beyond their window.
THIRD PARTY PAYORS
Our office does not bill third party payors, such as motor vehicle accident claims or worker’s compensation claims. If you wish to see our doctors for a visit that would normally require us to bill a third party payor, you are required to pay for the visit and/labs in full as a self-pay patient, and we will provide you with what you need to submit the claim yourself.
As an advocate for our young patients, ABCD Pediatrics will not intervene in any custody dispute or financial responsibility dispute between parents or other responsible parties. We will send statements to any one address provided; however, we cannot look to more than one party for financial responsibility.
MISSED/LATE CANCELLED APPOINTMENTS
We require a 24 hour notice for cancelation of a Preventative Visit/Well Check-Up, and a 2 hour notice for a Sick Appointment. This courtesy will allow others to be seen in a timely manner. If you are more than 15 minutes late for your scheduled appointment, the physician will have to determine whether the appointment will need to be re-scheduled. Missed appointments will be subject to a NO-SHOW fee as follows:
1st Missed Appointment $35
2nd Missed Appointment $75
3rd Missed Appointment $100
After the 3rd No Show, you may be asked to find another healthcare provider.
ABCD Pediatrics reserves the right to charge the following fees:
Medical Records $25.00
School/Sports/Camp/Daycare $ 5.00
Authorization for Services/Medication $ 5.00
FMLA Paperwork $25.00
Missed Appointments/No Show Fees $35/$75/$100
Emergency Walk-in Fee $25.00
We welcome the opportunity to discuss any aspect of our financial policy. Please ask to speak with the Office Manager if you have any questions, comments, or concerns. We thank you for your support and look forward to serving you in the future.
The Guarantor hereby acknowledges that they have received a copy of the Practice Notice of Privacy Practices and that they understand their rights and responsibilities concerning this notice. A copy of this notice is posted at the ABCD Pediatrics website and in the lobby of any Practice Office.
Certified Pediatric Nurse Practitioners (CPNP) Consent
Practice has on staff Certified Pediatric Nurse Practitioners to assist in the delivery of pediatric medical care. A CPNP is not a doctor, but a nurse who has received advance education and training in pediatric health care. A CPNP can diagnose, treat and monitor common acute and chronic diseases as well as provide health maintenance care. A CPNP can treat minor lacerations and other minor injuries. All Practice CPNP's work under the direct supervision of a Physician.
Billing Complaint Procedures
Billing complaints should be made in writing or via telephone to the attention of the Insurance/Billing Revenue Cycle Manager. Parents can find an email link to this individual from our website, http://www.abcdpediatrics.com. If resolution is unsatisfactory to parent, parent may request a review by the practice's physicians/owners.