Working with Insurance

As a courtesy to our patients, we will file the necessary forms so that you receive the full benefits of your medical coverage. We ask that you read your insurance policy to be fully aware of any limitations of the benefits provided. If your insurance company denies coverage or determines that a rendered service is not a covered benefit of your plan,  you are responsible for the remaining balance. Your coverage is a contract between you and your insurance company and/or your employer and your insurance company. Although we will make a good faith effort to assist you in obtaining your benefits, we cannot force your insurance company to pay for the services we have provided to you. 

Arbor Pediatrics does not get involved in disputes between divorced, separated or custodial  parenting arrangements regarding financial responsibility for their child's medical expenses. We bill one guarantor and do not handle billing or insurance coverage disputes between parents. The individual bringing in the child for services will be financially responsible for any copayment or unpaid charges.

 

Administrative Fee for Non-Covered Services

In order to provide full-access care as your child’s medical home, we provide unlimited form completion for school/camp/sports, medical letters of necessity, non-medical insurance forms such as FMLA, disability, life and other administrative services. We offer daytime and after hours access through our secure texting app Spruce and our online patient portal My Kid’s Chart. Phone calls, insurance authorizations, emails, portal messages, refills, form completions and coordination of care with specialists are services that are vital for quality pediatric care but are not covered by insurance. To provide high quality of care in a small personal setting, we charge a nominal fee of $25.00 per patient annually. Insurance will not cover this fee and it is the responsibility of the parent/guardian.

 

Autopay (Credit Card on File)

Arbor Pediatrics is committed to making our billing process as simple and as easy as possible. To that end, we require a credit card on file for all patients. Copays, coinsurance and deductible payments due at time of service will be processed using the credit card on file. Once the insurance claim has been processed, any patient responsibility will be processed using the credit card on file. If a credit card is not kept on file, charges are not paid at time of service or the subsequent credit card on file processing is declined, the account will be considered past due and a $25 late fee will be incurred.

It is your responsibility to update your credit card when it expires or is replaced. You give permission to Arbor Pediatrics to charge your credit card for any patient balance due on the account. If you have insurance coverage and there is an outstanding balance after we submit the claims, your card will be charged for the remaining balance.

 

Outstanding Balances

Any outstanding balance that is due from the patient is payable in full. In the event a patient presents for a visit and has an outstanding balance, a request for payment will be made. Parents/guardians with delinquent accounts and the inability to pay may need to reschedule. If over 60 days past due, the collections process may be initiated. Should the account be referred to collections, you will pay all reasonable fees and collection expenses, and you understand that all delinquent accounts bear interest at the legal rate. You will be able to receive emergency care for your children for 30 days but will not be able to schedule appointments until the account is settled.

 

Appointments/Cancellation

At Arbor Pediatrics, we respect your time and ask that you respect ours as well. While we do offer same day appointments, all of our appointments are scheduled in advance and we don’t offer walk-ins. We understand life is busy, if you need to cancel or reschedule your child’s appointment, we will be happy to do so but ask that you make appointment changes no later than 12 hours before your appointment time. Appointments that are missed or canceled without 12-hour notice are assessed a $60.00 fee for sick visits and a $100.00 fee for check-ups. Appointments that are scheduled for the same day and then canceled or missed will be charged $60.00. Repeated no-shows will result in the family being discharged from the practice. Patients who arrive late for a scheduled appointment may need to reschedule the visit and may be subject to the missed appointment fee.

Well Visits

Routine wellness visits are standard of care in pediatric. Developmental screenings, fluoride varnish, hearing and vision screenings and immunizations may or may not be covered by your insurance but are considered standard of care. Additionally, we are required to document all services provided during these visits. If there are ADDITIONAL concerns or conditions that arise, these will be additional codes and charges and may result in a copayment being applied to the visit. 

 

After Hours

Business hours at Arbor Pediatrics are weekdays 8:00-5:00. Services rendered outside of these times are considered after hours. We are required to document after hours care with CPT codes 99050 and 99051. A fee applies to these codes and may not be covered by your insurance policy.

Agreement

I have read and understand the financial policy of Arbor Pediatrics and agree to abide by it's guidelines which include the following:

• Arbor requires a credit card on file
• A $25 annual fee for administrative services not covered by insurance
• A required 12-hour appointment cancellation policy
• A late cancellation fee or no-show fee of $60 for sick visits and $100 for well visit

I authorize Arbor Pediatrics to submit each visit and service to my insurance company on my behalf and authorize the release of any medical or other information for the purpose of providing care or securing payment for services rendered. I authorize the payment of medical benefits directly to Arbor Pediatrics. I agree that I am financially responsible for any charges not covered by my insurance carrier including but not limited to: copayment, coinsurance and deductibles and I am to pay any of these non-covered charges at the time of service.

I authorize Arbor Pediatrics to securely store a credit card on file and to charge my credit card for balances due after my insurance company has processed claims for services rendered and determined my financial responsibility.

I understand this authorization remains in effect until I cancel it. To cancel, I must give 60 days notice in writing and my account must be in good standing.

This authorization applies to the patients listed below: