Our goal is to provide and maintain great physician-patient relationships. Letting you know in advance about our financial policies allows for a good flow of communication. Please read this carefully and if you have any questions, please do not hesitate to ask a member of our front office team. 

 

Fees for Service 

We encourage all patients who have concerns about the cost of care to inquire about those costs in advance of service. Garden Pediatrics follows the American Academy of Pediatrics (AAP) guidelines for care provider to our patients. We will administer care according to those guidelines and patients may incur associated fees.  

 

"Cash” Policy 

If patients have no insurance or have an insurance that we are not in network with, we offer direct cash pay prices (can be check or credit card as well). Payments must be made at the time of visit.  

We also offer a concierge service which has additional costs and benefits.  

 

No show, Cancellation and Late Policies 

Please arrive 15 minutes before you’re scheduled to see your doctor or PNP. During this time, we will check you in, collect any co-pays or co-insurances, update any registration information and prepare for your child’s visit by taking vitals and measurements. Arriving on time prior to your appointment allows your doctor or PNP to see you at the scheduled time. If you no-show to an appointment, or don’t reschedule prior to one full business day before your appointment (which counts as a no-show), a $100 no-show fee will be billed. If you have IEHP insurance, no-show fees are not chargeable, therefore this will count towards our two no-show criteria for reassignment to another office. 

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For patients in networks in which we participate: 

We are in-network with most PPO insurances. We also take a limited number of patients with IEHP patients.  

Your contractual payment (co-pay, co-insurance, deductible) is due at the time of service. It is our policy and contractual obligation with your insurer to collect co-payments, co-insurance and deductibles at the time of service. Insurance carriers change their requirements and their participation regularly, so contact your carrier for the latest information about your program. 

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Please follow these steps to ensure proper processing of your insurance plan coverage:

 

1. On arrival, please check in at the front desk and present your current insurance card at every visit. You will be asked to sign and date the file copy of the card any time there is an insurance change. This is your verification of the correct insurance and consent to bill the insurer on your child’s behalf. If the insurance company that you designate is incorrect, the insurance company to which the claim is submitted will be denied by them and you will be billed for those services. Most insurance companies have timely filing limits, and by the time a claim is denied, it may be too late to collect from the correct insurance company. Therefore, you will be responsible for payment even if your correct insurance company denied the claim. 

2. If Garden Pediatrics is your primary care physician, please make sure that our name or phone number appears on your card (if applicable). If your insurance company has not been informed that we are your primary care physician as of this date, you may be financially responsible for the visit because they will deny payment to us for services rendered if we are not the physician on file in their system. 

3. According to your insurance plan, you are responsible for paying all co-payments, deductibles, and coinsurances, and we have a contractual obligation with your insurer to collect those payments. We will submit to secondary insurance plans but please clearly inform us if more than one insurance and which one is primary. You must inform us if there are multiple insurances.  

4. Please make it a priority to understand your benefit plan, regardless of how complex it seems to be. It is your responsibility to know if a written referral or authorization is required to see specialists, if preauthorization is required prior to a procedure, and what services are covered. If you are not sure what is required, we are happy to have you call your insurance company from our office and find out prior to the services being rendered.

5. If you owe us a balance (except if there is a payment plan in place) we require that for scheduled appointments all prior balances must be paid prior to that visit.

6. Co-payments and co-insurances are always due at the time of service. A $10 processing fee (or service fee) will be charged in addition to your co-payment if the co-payment is not paid at the time of service or by the end of the next business day, as it costs us at least that much to bill you for it.

7. Once we receive your insurance plan’s explanation of benefits (EOB, which your insurance sends you simultaneously), any balances due from you will be billed upon receipt of that explanation. Your payment is due within 10 business days of your receipt of your bill.   

8. Account balances outstanding greater than 30 days (about 4 and a half weeks) will incur interest at 20% per month, billed monthly, until the balance reaches $0. Garden Pediatrics uses external agencies who report to credit agencies, where required.

9. Banks charge us for returned checks and it costs us to reprocess your bill and follow up with you, so if any checks are returned for insufficient funds, we will need to charge you a $25 fee PLUS any bank fees incurred.

10. Advance notice is needed for all non-emergent referrals, so please give us 3 to 5 business days to create a referral for you. While we will make every effort to refer you to a physician participating in your plan, it is your responsibility to know if that selected specialist participates in your plan. Your plan may not cover referrals to out-of-network providers, so those charges may be billed directly to you.

11. Before making an annual physical appointment, check with your insurance company whether the visit will be covered as a ‘well’ visit. Some insurances pay for one visit per calendar year in ages over three, while others require a year from the last well visit. For any services not covered, you will be responsible for payment at the time of visit.   

12. Not all services provided by our office are covered by every plan. Any service determined as ‘not covered’ by your plan will be billed to your account, so please check with your insurer about any services that may be excluded in your policy.