Financial Policies

Below are the financial and office policies that we ask patients or guardians to sign at each appointment

Assignment of Insurance Benefits

I hereby authorize direct payment of medical benefits to Children’s Physicians, Inc. for services rendered by him/her in person, under his/her supervision.  I understand that I am financially responsible for any balance not covered by my insurance.

Authorization to Release Information

I hereby authorize Children’s Physicians, Inc. to release any medical or incidental information that may be necessary for either medical care or in processing applications for financial benefit.

Privacy Policy

I have received a copy of the Privacy Policy of Children’s Physicians, Inc.

Medication History

I give permission to Children’s Physicians, Inc. to use the electronic medical system to obtain my/my child’s prescription medication history 

Preventative Health Visit Policy

I have received a copy of the preventative health visit policy, and understand that an office visit and a preventative well visit are separate encounters and carry a separate charge. 

Communication

I hereby give Children’s Physicians, Inc consent to contact me by telephone for appointment reminders and office updates.  The office may utilize text messaging for communication as well, and I understand that I can let the office know if I choose to opt out of this option.  

I will notify the office if I do not wish to have messages left on my answering machine or voicemail

I am aware of the option to sign up for the patient portal.  I will provide my email address to the office so that I might be enrolled in the patient portal. 

Cancellation and No-Show Policy

Failure to cancel a scheduled appointment within 24 hours of said appointment time will result in a fee of $40.00, per the office policy of Children’s Physicians, Inc.  

Copay Policy

Failure to pay your copay at the time of service will result in a $10.00 charge.  A grace period of 24 hours will be given to pay a copayment due. 

Insurance Coverage

It is the responsibility of the patient (or guardian) to know the coverage of their insurance.  We cannot guarantee that our physician’s services are covered on any given insurance plan.  Insurance providers do provide this information to its enrollees.  

Well Child Care

It is the responsibility of the patient (or guardian) to know the rules of their insurance in terms of well child care (one visit per calendar year, versus one visit every 365 days).  If a visit is scheduled that is not covered by insurance, it is the financial responsibility of the patient.