Any deductible, co-payment, co-insurance or balance is due at the time of visit before consultation with the Doctor.
Insurance health plans create networks that certain providers are selected to be a part of. We may be IN NETWORK with some plans offer by an insurance company; however, we might not be IN NETWORK with the type of plan you have. It is the patient’s responsibility to confirm if we are IN NETWORK with your health plan. If our office is in network with your insurance, the patient is still fully responsible for services rendered. Your insurance may not cover the services or may only partially cover them. The office can make no guarantee of actual payment by your insurance company. Even though an insurance claim has been filed, you may still receive a statement each month from our biller who will provide you with the outstanding balance due on the account, since you, not the insurance company is ultimately responsible for payment on the account. It is the parents, guardian or patient’s responsibility to provide the office with any new or updated information when it comes to new insurance, change of address, phone numbers or credit card information. Our office will be keeping credit card information on file. The office will continue to mail out and email statements. You will have the option to self-pay online, pay in person, mail in a check or pay over the phone by contacting the office. If we do not receive payments after two months, we will automatically charge your credit card on file with an additional $10 fee.
I authorize the release of any medical information to my insurance carrier that is necessary for processing of claims. I authorize payment of medical benefits directly from my insurance carrier to California Kids Pediatrics, Leila Bozorgnia, M.D., for services provided.