Financial Policies
Effective January 1, 2010
To our valued patients: Thank you for choosing us as the health care provider for your children. We are committed to their care and treatment. Please understand that payment of your bill is considered a part of this treatment. We are doing everything possible to hold down the cost of medical care, and you can help a great deal by eliminating the need for us to bill you. The following is a summary of our payment policy effective January 2010. Please let us know if you have any questions. We are here to serve you.
The Physicians of
ALL PAYMENT IS EXPECTED AT THE TIME OF SERVICE
(Now collected PRIOR to the patient appointment time.)
Payment is required at the time services are rendered unless other arrangements have been made in advance. This includes applicable coinsurance and copayments for participating insurance companies. Johnson County Pediatrics accepts cash, personal check (in state KS/MO only), VISA, MASTER CARD, and DISCOVER. There is a $25.00 charge for returned checks. If you do not have your co-pay at the time of service a late fee of $10.00 will be assessed unless you call us with a credit card number or return with your payment before the end of the business day.
Patients with an outstanding balance of 60 days overdue must make arrangements for payment prior to scheduling appointments. Please be aware that health insurance coverage varies and some, or perhaps all, of the services provided may be non-covered services. We realize that people have financial difficulty, and therefore, if your child has no immunization coverage, we may advise that due to your financial situation you seek your child's immunizations through a clinic or health department.
We bill participating insurance companies as a courtesy to you. As part of our contract with your insurance company, all office co-pays, coinsurance, and deductibles are required to be paid by you. You are responsible for all non-covered benefits and agree to pay any balance that remains after benefits have been determined by your insurance company. If your insurance is non-responsive and does not make timely payment on your behalf, then we will bill you and payment becomes your responsibility.
We only bill secondary insurance companies with whom we have a contract agreement and only if we have the necessary information.
If we do not bill your insurance plan, we will provide you with a copy of the encounter form for each office visit. This form will have all of the information and coding necessary for you to submit your claim to your insurance company. All services must be paid in full at the time of the visit and your insurance company should reimburse you directly.
Responsible Party: We ultimately hold both parents responsible for payment. In circumstances where the parents are separated or divorced, Johnson County Pediatrics will not act as a mediator in collecting our payments. If the account is not resolved in a timely manner, both parent's information will be submitted to our collection agency.
Questions regarding billing may be addressed through our billing company, Total Medical Management, at 913-362-9777, Monday through Friday, 8:00 am to 5:00 pm.
MISSED APPOINTMENTS/LATE CANCELLATIONS
Missed appointments represent a cost to us, to you and to other patients who could have been seen in the time set aside for you. Cancellations are required 24 hours prior to the appointment. A charge of $50.00 for any appointment cancelled late (less than 24 hours prior) or missed appointment will be assessed to your account. Excessive abuse of missed appointments may result in discharge from the practice.
SCHOOL FORMS/DAYCARE FORMS/CAMP PHYSICAL FORMS/ALL OTHER FORMS NOT NOTED
We are happy to complete ONE form per patient at a SCHEDULED WELL VISIT. Additional forms needing completion will be assessed a fee of $10.00 per form. We encourage you to keep your child's immunization card completed and up to date. Requested forms not completed at your child's well check up will be completed within 72 business hours and will be available for pick up at the front desk. Forms will be mailed if the parent/guardian provides a stamped, self-addressed envelope.
Forms requiring emergent completion (less than 72 business hours), FMLA forms, and Guardianship forms will be assessed a fee of $25.00.
I have read and understand the Johnson County Pediatrics financial policy. I agree to assign insurance benefits to Johnson County Pediatrics whenever necessary. I also agree that if it becomes necessary to forward my account to a collection agency, in addition to the amount owed, I also will be responsible for the fee charged by the collection agency for costs of collections.
FREQUENTLY ASKED QUESTIONS:
Q: What if I forget my Insurance card:
A: If insurance coverage can not be verified, you will be expected to pay in full at the time of service. If you are unable to pay the charges in full, you may be asked to reschedule your appointment or make payment arrangements with our billing department prior to your visit.
Q: What happens if I can't pay my co-payment?
A: If you forget your checkbook, credit card, or cash you may call the office prior to the close of the business day on which your child was seen with your credit card number and you will not be assessed the $10 processing fee.
Q: My divorce decree states that my ex-spouse is responsible for all charges incurred. What if my ex doesn't pay?
A: We ultimately hold both parents responsible and will try to resolve the balance in a timely manner. If we are unable to resolve the account, it will be sent to collection with both parents information.