Financial Policy

Welcome to Johnson County Pediatrics.

Thank you for choosing us as the health care provider for your children. We are committed to affordable and quality healthcare. Due to many questions regarding patient and insurance responsibility for services rendered, we have decided to develop a financial/payment policy. Please read it, ask any questions you may have, and sign at the bottom of the page. A copy can and will be provided to you upon request.

Johnson County Pediatrics is 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 2013.

  1. Proof of Insurance. All patients or responsible parties must complete our patient information form. We must obtain a copy of your current insurance card to provide proof of coverage. If insurance coverage cannot 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.
  2. Insurance. We participate in most insurance plans. If you are not insured by one of the plans that we participate with, payment in full is expected at time of service. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions regarding your coverage. 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. If you have an HMO plan, please sign the HMO form.
  3. Co Pay and Deductibles. All co-pays and deductibles must be paid at the time of service. This is part of your contract with your insurance company.
  4. Payments. We accept Cash, Check, Visa, MasterCard and Discover. A $25 fee will apply to any check that is returned for any reason.
  5. Claim Submission. We will submit your claims directly to your insurance company as a courtesy. Please be aware that insurances vary on which services they cover.
  6. Non-Covered Services. Please be aware that some services received may be non-covered or not considered necessary by your insurer. You must pay for these services not paid by your carrier.
  7. Nonpayment. If your account is over 90 days past due, you will receive 2 letters to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency.
  8. Missed appointments. Missed appointments and appointments cancelled at the last minute represent a cost to us and to other patients who could have used the time. Please call ahead to make any scheduling changes. Our policy is to charge $ 25 for missed appointments not canceled with 24 hours notice. These charges will be your responsibility and billed directly to you. Please help us serve you better by keeping your regularly scheduled.
  9. School and Camp Forms. We encourage you to keep your child’s immunization card completed and up to date. In order to complete a form for school or camp we require three to five business days. We can complete a form based on well checks performed within the previous 365 days. Forms - with demographic information completed - can be submitted in person at our office, via fax at 913.384.5209, or through email at We do not accept blank documents. In order for us to complete forms for high school students you must fill out the entire page-one questionnaire. You will be notified when the forms are completed. Once completed the forms can be picked up at our office, they can be mailed if the parent/guardian provides a stamped, self-addressed envelope or may be obtained through our patient portal if you have registered your child on the portal.
  10. Procedures. There are procedures that may be done in the office that may not be processed by insurance companies as part of the office visit. Those procedures are billed separately and may be applied to your deductible. Those procedures can include, but are not limited to: wart treatment, eye exam, hearing exam, fluoride treatment or labs done in the office.