Working with Insurance

As a courtesy to our patients, we will file the necessary forms so that you receive the full benefits of your medical coverage. We ask that you read your insurance policy to be fully aware of any limitations of the benefits provided. If your insurance company denies coverage or determines that a rendered service is not a covered benefit of your plan,  you are responsible for the remaining balance. Remember that your coverage is a contract between you and your insurance company and/or your employer and your insurance company. Although we will make a good faith effort to assist you in obtaining your benefits, we cannot force your insurance company to pay for the services we have provided to you. 

 

Autopay (Credit Card on File)

Arbor Pediatrics is committed to making our billing process as simple and as easy as possible. To that end, we  require a credit card on file for all patients. Copays, coinsurance and deductible payments due at time of service will be processed using the credit card on file. Once the insurance claim has been processed and the Explanation of Benefits (EOB) received, any patient responsibility will be processed using the credit card on file. If there is no credit card on file, all charges must be settled at the time of service. If charges are not paid at time of service or the subsequent credit card processing is declined, the account will be considered past due and a $25 late fee will be incurred.

It is your responsibility to update your credit card when it expires or is replaced. You give permission to Arbor Pediatrics to charge your credit card for any patient balance due on my account. If you have insurance coverage, your card will be charged AFTER your insurance has paid their portion. 

 Patients without Insurance Coverage/Non-Covered Expenses

We are happy to work with patients that prefer to pay directly for services or do not have insurance. For such patients, a time of service discount will be applied to the bill if settled in full on the day of service. This discount does not apply after the day of the visit. The same discount will be applied to any non-covered charges for patients with insurance if paid at the time of service. This discount does not apply toward the “patient responsibility” portion of covered charges as those charges have already been discounted through the contract we have with your insurer.

 

 Balances

Any outstanding balance that is due from the patient is payable in full upon receipt of the statement. In the event a patient presents for a visit and has an outstanding balance, a request for payment will be made. Patients with delinquent accounts and the inability to pay may need to reschedule. If over 60 days past due, the collections process will be initiated. Should the account be referred to collections, you will pay all reasonable fees and collection expenses, and you understand that all delinquent accounts bear interest at the legal rate. You will be able to receive emergency care for 30 days but will not be able to schedule appointments until the account is settled.

 

Administrative Fee  

In order to provide you full-access care, we provide unlimited form completion for school/camp/sports, medical letters of necessity, non-medical insurance forms such as FMLA, disability, life and other administrative services. We also offer access to you on our website, through our online patient portal, and after hours. These services are not covered by insurance. There is a fee of $25.00 per patient that will be charged to your credit card annually. This is the responsibility of the patient and cannot be submitted to any insurance carrier.

 

Appointments/Cancellation

At Arbor Pediatrics, we respect your time and ask that you respect ours as well. We will send appointment reminders via phone, email or text messaging. If you need to cancel or reschedule your appointment, we will be happy to assist you. Please make appointment changes no later than 24 hours (1 business day) before your appointment. Appointments that are missed or cancelled without 24-hour notice are assessed a $50.00 fee for sick visits and a $75.00 fee for checkups. Appointments that are scheduled for the same day and then cancelled or missed will be charged $50.00. Repeated no-shows will result in the family being advised to transfer care out of the practice. Patients who arrive late for a scheduled appointment may be asked to reschedule for the visit and may be subject to a missed appointment fee.

Well Visits

Arbor Pediatrics strives to keep you as healthy as possible. Routine checkups should be scheduled within a month of your birthday. Certain health and developmental screening, such as the ASQ developmental questionnaire, fluoride varnish to prevent dental caries, hearing and vision screening for early detection of abnormalities and administration of immunizations may or may not be covered by your insurance. In compliance with the American Academy of Pediatrics and state requirements, we follow Bright Future Guidelines to provide the highest standard of care. We are required to document all services and it is your financial responsibility should your insurance not cover routine wellness assessments. During well visits, if any ADDITIONAL concerns or conditions arise, these will have additional codes and charges and may require a copayment at your child’s well visit. 

After Hours

Business hours at Arbor Pediatrics are Monday through Thursday 8:00-5:00 and Friday 8:00-3:00. Services rendered outside of these times are considered after hours. We are required to document after hours care with CPT codes 99050 and 99051. A fee applies to these codes and may not be covered by your insurance policy.

I have read and understand the financial policy of Arbor Pediatrics and agree to abide by its guidelines. 

I authorize Arbor Pediatrics to submit each visit and service to my insurance company on my behalf and authorize the release of any medical or other information for the purpose of providing care or securing payment for services rendered. I authorize the payment of medical benefits directly to Arbor Pediatrics. I agree that I am financially responsible for any charges not covered by my insurance carrier including but not limited to: copayment, coinsurance and deductibles and I am to pay any of these non-covered charges at the time of service.

I authorize Arbor Pediatrics to securely store a credit card on file and to charge my credit card for balances due after my insurance company has processed claims for services rendered and determined my financial responsiblity.

I understand this authorization remains in effect until I cancel it. To cancel, I must give 60-days notice in writing and my account must be in good standing.

This authorization applies to the patients listed below.