Pediatric Associates is committed to providing you with the best possible care and will be pleased to discuss our professional fees with you at any time. Your clear understanding of our financial policy is important to our professional relationship. Please ask if you have any questions regarding our fees, financial policy or your responsibility.
Our office follows the American Board of Pediatrics guidelines, which requires all patients to receive annual preventive care visits and required immunizations. In these visits, the physician does a complete health examination. If wellness visits are reluctant to be scheduled or kept, this will result in the child and all siblings to be discharged from our practice.
As we do understand emergencies arise, please be courteous and cancel or reschedule your appointment at least 24 hours in advance. If you have an appointment that is “no call no show” you will be charged a $25.00 office fee. No insurance plan reimburses this charge and patient will be responsible in full.
Three or more missed appointments without notice will result in a discharge from the practice.
There will be a $10.00 after hours consultation fee for all calls made to the doctor or nurse after normal business hours. No insurance reimburses this charge and patient will be responsible in full. Anytime after regular office hours, you may leave a message for the office staff to return your call at (352) 369-8700 or you may reach to On-Call Physician or Nurse at (352) 369-8700 and press 2 (following our voicemail instructions).
It is the policy of this practice NOT to accept Medicaid, except in those cases where Medicare is the primary payor and for On Call services only. Pediatric Associates does adhere to the Florida Medicaid Agreement and title 42 code of the federal regulation 447.20 and civil rights act of 1964.
Fees for services provided are due at time of service. If for any reason you are unable to pay upon check out you will be charged a $10.00 service fee in addition to the payment due at that time. I understand that my insurance company may require an authorization for services. If for any reason my insurance company does not give authorization for services incurred by the patient, I will be responsible for any and all charges.
Payment in full is expected at the time of service.
This practice participates with most insurance companies and will file a claim with your insurance carrier. You are expected to pay any deductibles, co-pays or percentages as required by your policy at the time of service. It is your responsibility to verify that Pediatric Associates participates with your insurance carrier.
If unable to verify coverage, you are expected to pay in full at the time of service and we will provide you with the necessary receipt to file a claim to get your reimbursement.
If a claim is denied due to insufficient patient information or updated patient information required from you, the balance of the claim will be the patient’s responsibility to pay, as well as, to contact your insurance company to correct and give the necessary information.
I, the below named parent or guardian of the patient named below, do hereby authorize Pediatric Associates to release to any third party payor or provider any and all medical information and records concerning diagnosis and treatment in connection with determining a claim for payment for such treatment and or diagnosis or when required by a third party provider in the assessment, planning and or implementation of care.
I agree that should the amount of insurance benefit be insufficient to cover the expenses, I will be responsible for payment of the difference. I will be responsible for the entire amount due (excluding disallowed amounts per a managed care contract) for services rendered if the expense is non-covered under the policy. I understand that Pediatric Associates will not become involved in disputes between me and my insurance company, regarding deductibles, co-payments, covered charges and or usual and customary charges other than to supply factual information as necessary.
*The undersigned will pay all costs and expenses including a reasonable attorney fee incurred or paid by Pediatric Associates in the collection of this obligation by suit or otherwise the entire amount is due and payable upon billing.
*This agreement shall remain in effect until revoked by me in writing; I also permit Pediatric Associates to use a photocopy of these assignments to be used in place of the original on file at Pediatric Associates.
*Children of divorced parent’s- we do not become involved in disputes between parents and divorce decrees. The parent or guardian accompanying the child at the time of service will be responsible for payment.