Thank you for choosing Pediatric Neurology Associates as your health care provider. The following is a statement of our Financial Policy, which we require you to read prior to your appointment.
All patients must complete our Registration and Medical History forms before seeing the doctor. You must supply us with your insurance card, social security number and driver’s license prior to your visit.
FULL PAYMENT IS DUE AT THE TIME OF SERVICE.
WE ACCEPT CASH, VISA, MASTERCARD and DISCOVER.
Contracted Insurance Plans: Although we have contracted with your insurance company to provide care to their clients, your insurance policy is a contract between you and your insurance company. All co-pays, deductibles and co-insurance percentages are due prior to treatment, along with a valid referral from your primary care provider, if your insurance plan requires it.
Non Contracted Insurance Plans: You are responsible for payment of all services rendered. To assist you, we will bill your insurance company. We cannot bill your insurance company unless you give us your insurance information. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract.
Usual and Customary Charges: Our practice is committed to providing the best treatment for our patients. We charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates. You will be responsible for payment if your insurance carrier authorizes and certifies care but fails to pay as agreed upon.
Minor Patients: The adult accompanying a minor and the parents (or guardians of the minor) are responsible for full payment. For an unaccompanied minor, non-emergency treatment will be denied unless payment arrangements have been made in advance.
Missed Appointments: Unless canceled at least 24 hours in advance, our policy is to charge for missed appointments at the rate of $25.00. This is not covered by insurance. Please help us serve you better by keeping scheduled appointments.
Collections: You may be dismissed from the practice if you fail to meet your financial responsibilities and/or we must use a collection agency to bring your account up-to-date. If it is necessary to turn the account over to collections and you wish to return to the practice, you will be responsible for all charges, including those incurred to collect the amount owed, i.e. collections agent’s fees.