JDC PEDIATRICS FINANCIAL POLICY
We are committed to providing you with the highest quality medical care. This goal is best achieved if everyone is aware of our policies. Your clear understanding of our financial policy is very important to our professional relationship.
Scheduling and arriving for an appointment at our office is implied consent for all services to be performed which are medically- and age-appropriate for your child as recommended by the American Academy of Pediatrics. Only services which may involve potential risk of injury or infection (e.g., wart removal, administration of vaccines and/or medications) will require additional consent. All services performed may or may not be fully covered or paid by your insurance, and JDC Pediatrics is not responsible for investigating individual insurance benefits. Noncovered and unpaid costs of services are your responsibility.
It is your responsibility to know the limits and coverage of your health insurance policy and to show your cards to us at each visit.
We will make clinical recommendations that we think are in your best medical interest, but we cannot guarantee that your policy will cover the charges incurred. We follow AAP (American Academy of Pediatrics) guidelines and recommendations.
If you have a copay, it is expected to be paid at the time of service. If you are unable to comply, a $20.00 billing surcharge will be added to your account.
If we do not participate with your insurance or health plan, we expect payment at the time of service. We will be happy to file your claim for services if you have given us all the required and correct information.
Regardless of participation, we will not become involved in disputes between you and your insurance company regarding deductibles, copays, covered/non-covered charges, etc, other than to provide information as necessary. If such a dispute occurs, the balance will become your responsibility and must be paid promptly.
If you have any questions regarding the payment allowance by your insurance company, please contact your insurance company.
Patient billing statements are generated every four weeks. A $10 penalty fee will be charged for each subsequent statement printed and mailed for charges appearing on the first billing which are not paid in full. Please be aware if the payment is to be issued from another source (such as an HSA, FSA, or bank bill pay system) this penalty fee will still be incurred if another bill is produced, regardless of when you made the request for the payment.
If your account becomes 90 days delinquent, we will begin collection/discharge proceedings and a 33% additional fee will be added to your account to cover the fee charged by the collections agency. Additionally, we will have no choice but to terminate our physician/patient relationship. To avoid collections, you may set up an approved budget plan with our billing office using your credit card.
If your personal check is returned unpaid from your bank, a $35 returned check fee will be added to your account and we reserve the right to place your account on a ‘cash only’ basis.
The parent/legal guardian/authorized adult accompanying the minor child is responsible for payment, regardless of legal or custodial arrangements. We do not get involved in financial disputes between parents; the parent who brings the patient for services is expected to pay copays and non-covered services at the time of service. Subsequently, bills will be sent to the address of record and the parent who lives at that address will be responsible for payment.
When your child is seen for preventive care (also known as a “well visit,” “check up,” or “routine care”) there may be times when he or she needs a service that is not considered preventive on the same day as the well visit. If your child is not well, a problem is found that needs to be addressed, or you would like to address a problem unrelated to the well visit, the physician may need to provide an additional office visit service (called a “sick visit” or “office visit”) to care for your child. This is a different service and is billed to your health plan in addition to the preventive services provided on that day. Certain circumstances may require you to schedule a separate appointment for these types of issues. If you have a co-payment for office visits, it must be paid at the time of service. Any coinsurances or deductibles must be paid upon receipt of our first billing statement. Some services that may be provided and billed in addition to preventive services include:
- The doctor’s work to address more than a minor problem, which will be billed as an office visit (e.g., if the doctor gives a prescription, orders tests, or changes care for a known problem)
- Medical treatments (e.g., breathing treatments or wart treatments)
- Any surgery (e.g., removing splinters or something the child put in his ear or nose)
- Tests performed in the office that are not included in the Bright Futures plan
- Discussion of Oral Contraceptives
Our office does not want you to be surprised by a bill but must always bill your health plan based on federal guidelines and the actual services provided. Please feel free to ask questions about services that may not be paid in full by your health plan on the day of your visit. Bills and claims sent to insurance are not final until reviewed by our billing department.
We realize that financial problems may affect timely payment of your account. We encourage you to contact our billing department promptly to work out payment arrangements.
Broken appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. We reserve the right to charge a fee for cancelled or missed appointments. We request 24 hours notice for cancellation of appointments. If an appointment is missed that was scheduled in the same day, a $50.00 fee will apply. A $50.00 fee will be charged for a second missed appointment. The third missed appointment will result in discharge from the practice. A $50 fee will be charged to new patients when the first appointment is missed.
When our office is closed overnight, and you have an urgent issue that cannot wait until morning, you can call our office and be connected to our nurse triage service line. It is staffed by pediatric nurses who will give you advice on the management of your child’s problem and help you decide if or when you need to seek medical care. There is a charge for this service so if your concern is not urgent, you may want to wait until our office reopens. You will be alerted at the beginning of the call if you are going to be assessed a charge. If the nurse determines that your concern is urgent, she will contact our physician on call and he or she will contact you. You may want to check the ‘Is Your Child Sick?’ section of our website for helpful information before using this service.
URGENT CARE VISITS:
JDC will see your child after-hours for urgent concerns on weekday evenings, Saturdays and Sundays by appointment. Patients will be seen at our Camp Hill office or if possible, via video visit. Only certain concerns can be treated via a televisit. Please call us at 717-791-2680 to schedule a same-day appointment. There will be an additional after-hours fee charged for this type of visit.
ASSIGNMENT AND RELEASE:
I hereby authorize that my insurance benefits be paid directly to the physician. I understand that I am financially responsible for all charges whether or not said charges are paid for by my insurance. I also authorize the physician to release information required in the processing of insurance claims.
I HAVE READ AND FULLY UNDERSTAND THE FINANCIAL POLICY SET FORTH BY JDC PEDIATRICS. I UNDERSTAND AND AGREE THAT THE TERMS OF THIS FINANCIAL POLICY MAY BE AMENDED BY THE PRACTICE AT ANY TIME WITHOUT PRIOR NOTIFICATION TO ME AND/OR THE GUARANTOR.
*You will be asked to sign this form electronically at your visit to our office*