Doctors for Kids, PLC, (DFK) is committed to providing exceptional health care care for  your child. As part of the relationship, a clear understanding of our office policy is important so you will know what actions DFK will be taking on your behalf as well as what your financial responsibilities are.

 

Responsible Party

The party that brings the child to the office will be responsible for the visit’s copay AND will also be the final responsible party on record.  We will not be involved in parental court cases. Co-Pays, coinsurance and/or deductible are due at the time of service or the visit may be rescheduled. Whoever brings the child to the office for a visit will be authorized to receive financial and medical information.  Information regarding a visit will be available on the portal.

 

Insurance

Please note that there are over 1000 plans and it is YOUR responsibility to become familiar with your plan. If you do not understand your specific plan coverage, please call your insurance plan or your HR department at work. The number for your plan is listed on your insurance card. Note that we do not participate in Medicaid.  We will bill your insurance plan as determined by our contract with each given plan. Copayments, deductibles, and coinsurance amounts are due at the time of service. 

If we do not participate in your plan, payment in full is required at the time of service, unless other arrangements have been made in advance. We may be able to bill your plan as a courtesy to you and credit your account if we receive any additional payment. 

Knowing your insurance benefits – including eligibility, covered benefits, and medically necessary procedures – is your responsibility. Please contact the customer service department at your insurance company regarding your coverage.  You are expected to know if vaccines, well-checks, labs or other procedures are covered or might fall into the deductible.  It is your responsibility to know if your well-check is made within the timeframe allowed by your insurance company.

You are responsible for any charges not covered by your insurance plan.

 

Proof of Insurance 

• All patients must complete and/or update our registration form at each office visit.
• You must furnish valid and up-to-date proof of insurance coverage and a copy of your driver’s license or other state-issued photo ID at each office visit.
• If you provide incorrect or expired insurance information you will be responsible for the balance due for that visit.
• Please notify us of any changes in your insurance coverage prior to your appointment.
• Insurance denials for termination of coverage will be automatically billed to you.

 

Copayments, Deductibles and Coinsurance 

• All copayments, unsatisfied deductibles and applicable coinsurance amounts must be paid at the time of service. By contractual law, your insurance company requires us to charge for, and you to pay for, all required copayments, coinsurance, deductibles and non-covered services.
• We will submit your insurance claims and assist you in any way reasonable to help get your claim paid.
• Your insurance company may need you to supply information directly to them. It is your responsibility to comply with their request(s) in a timely manner.

 

Payment for Services 

Your insurance plan requires that you present your insurance identification card(s) at each visit to ensure correct billing and eligibility information.  For those insurance cards listing the primary care physicians, one of our physicians must be listed in order to be covered by your insurance. 

The person accompanying the child is responsible for payment. 

An unaccompanied child or the person accompanying the child must provide payment, this includes a caregiver or family member.  

*Only people authorized by parent or guardian will be allowed to bring a child in for an appointment and will be required to show identification. 

 

In situations of divorced parents, the parent bringing the child into the office is considered the responsible party.  Divorce decrees are between you, your ex-spouse and the courts.   DFK has no authority and is not in a position to enforce compliance to divorce decrees.  

You will be responsible for charges incurred by children who have turned 18 until you notify us in writing, prior to services being provided, that you no longer accept financial responsibility. 

 

Billable services 

DFK will charge for provider services as well as supplies, screenings and laboratory services used for the care of your children. DFK will also charge all follow-up services accordingly.   

DFK charges for extended-time appointments (evenings-all appointments from 5:00PM to close and all weekend appointments). DFK provides care beyond normal business hours to help reduce timely and costly Emergency Center and Urgent care visits. 

Occasionally a patient will be scheduled for one type of service, but the provider may diagnose and treat another problem in addition to the scheduled service. When appropriate DFK will charge for the additional service. Some insurance companies will not cover both services provided on your children’s behalf, which may result in the responsible party owing additional fees. This frequently happens during Well Visits where other issues not related to the well visit are discussed.

DFK reserves the right to charge for extensive phone calls, reporting, forms, consultations, coordination of care with other providers and or other services. Your insurance company may not cover these services. 

 

Method of Payment 

DFK accepts cash, check (including cashier’s checks and money orders. No third party or post-dated checks), Visa and MasterCard(credit card payments can be made via  telephone at no additional charge). 

For your convenience we can keep your credit card number, expiration date, and signature authorizing payment in a secure protected field in your child’s account. This will help if you forget your wallet, or when someone else has your permission to bring your child for treatment. 

Payments can be made on-line via our secure portal. You must have a sign on and 
password to access the portal. 

 

Statements 

Account statements will be sent monthly for accounts that have a balance owed.   Statements will show both patient (private) and insurance (pending) amounts owed. Private balances are due upon receipt of a monthly statement. 

It is your responsibility to provide DFK with your correct address and phone number. If a statement is returned for invalid address, your account may be sent to an outside collection agency.

 

Overdue payments 

Please note, insurance companies are generally late in paying us.  Once they pay, and we post the payments to your account, you will get a statement during the following cycle.  It may happen that your balance may become more than 60 days overdue.  Please pay your balance immediately.  When your account is past due you are required to make arrangements with the billing department before scheduling any appointments for your child.   

Accounts over 90 days past due will be considered delinquent and will be referred to our collection agency. An administrative fee will be charged to your account.

If your claim is unresolved with your insurance company within 60 days of the date of service, we will contact you and ask that you check into the delay. If the claim is still unresolved after 90 days, you will be responsible for all charges.

 

Payment plan options 

When appropriate and at DFK’s discretion, DFK will offer monthly payment plan options to help manage your healthcare costs. Payments are due on or before the agreed date.  If payments are late or missed your account may be sent to an outside collection agency (See dismissal section).

Failure to follow any or all the payment plan requirements will render the agreement null and void.  Some services may be denied on accounts with high balances until the account is released by the billing department. Failure to pay balances or comply with a payment option may be cause for dismissal. 

 

Refunds and Overpayments

Should you feel you have made an overpayment to our office or are awaiting a refund based on  insurance reimbursement, please contact our Billing Office with questions. If you are entitled to a refund, our office will issue a refund check to the responsible party listed on the account, upon request. Due to the frequency of visits in primary care, if we do not receive a specific request for a refund, overpayment may be applied as a credit to the patient’s account and applied to future visits in our office. 

Should you have any questions about this agreement or any billing issues, we encourage you to discuss them with our Billing Office. We appreciate your dedication to our physicians and are happy to have you as part of our practice.  

 

Collections 

Accounts may be sent to collections but are not limited to the following reasons: 

• Invalid patient demographic information (address and phone number) which prevents us from contacting you regarding your account.
• Failure to provide timely and accurate insurance information.
• Failure to pay patient balances
• Failure to follow through with payment plan agreements.
• Failure to follow through with statement discrepancies, insurance denials or any other items outstanding on your account.
• Failure to follow through with other correspondence from DFK.

 

Returned Check Fee 

A service fee of $35.00 will be assessed for all checks returned for insufficient funds. If two checks are returned for insufficient funds, we will no longer accept your personal checks. 

 

Bankruptcy 

If DFK receives notice of a filed Bankruptcy case on your account, we will make the necessary adjustments according to bankruptcy law.   

At DFK’s discretion any children under the guarantor that filed bankruptcy will be dismissed from the practice.

 

Dismissal from Practice 

DFK reserves the right to dismiss patients from our practice for but not limited to non- payment, excessive missed appointments, inappropriate behavior, and failure to comply with our office policies. If you have an established history of non-payment on your account, you may be dismissed. 

Prior to dismissal, DFK will issue a letter from our practice informing you of our intent to dismiss. For delinquent accounts, you will receive a letter of intent to dismiss unless full payment to your account has been made. Payment in full includes your current and past account balances in addition to any amounts that have been referred to an outside collection agency. If payment is not made a letter of dismissal will be issued.  

If a dismissal letter is issued, DFK will provide urgent care only for thirty (30) days after the date of the letter to allow you time to find another health care provider for your child(ren). You will not be eligible to see any of the providers at Doctors for Kids after the 30 days have expired. 

 

Cancellation and Missed Appointments

If it is necessary to cancel your appointment, we require that you cancel AT LEAST 24 hours prior to the appointment.  Failure to cancel the appointment will result in a $40.00 fee.  As a courtesy we text or e-mail reminders, however, you are still responsible for the cancellation even if you did not receive a call and/or text. We reserve the right to discharge you from our practice for missing appointments frequently.

 

Newborns 

As a courtesy Doctors for Kids will hold all claims for newborns for up to thirty (30) days from the child’s date of birth as long as there is an active policy for the family. 

Newborn infants must be added to the insurance policy within 30 days of the date of the child’s birth. After thirty (30) days from the date of birth of your child, your active insurance policy will be billed. If your child has not been added to your policy, you will be responsible for all services provided and be billed directly. Please inform the office when your child has been added to insurance.                                            

 

Administrative Services, Charges and Patient Responsibilities: 

Due to the continued decline in reimbursement from insurance companies and their failure to pay for the following services, we are no longer able to absorb the cost of these services. Therefore, the following administrative services will be billed directly to you with payment being your responsibility. 

Our practice is committed to providing the highest quality of service to our patients while keeping our charges for administrative services at or below the usual and customary charges of other medical  practices in our area.  All such administrative fees must be paid prior to scheduling future appointments.

 

Telephone Consultations / After-hours Calls 

Telephone consultations/after-hours calls for medical advice/treatment may be subject to a fee that is billed directly to you. Fees for these services vary based on complexity and range from $25 to $75 per call. 

 

Requests for Medical Records 

In accordance with HIPAA law, DFK requires written requests for the release of medical records. There is a $25 administrative fee associated with retrieving and copying medical records when they are transferred to another physician.

Please take this into consideration when requesting copies of your medical records.

 

Health Appraisal, Sports, Camp, School.. All Other Forms  

These are available to our patients at every well child visit. If you require the office to provide you with a form outside of your visit there will be an administrative fee of $15.00 to be paid at the time of pick up or you can pay via the telephone, should you need your form faxed. For longer forms there is an administrative fee of $25.00. Due to the intensive and complicated nature of these forms they will not be able to be completed at the visit and will require a minimum of 5 business days to be completed