Office Policies & Procedures

Financial Policy

Insurance-We participate with most insurance plans. If you are not insured by a plan we have contracted with, payment in full is expected at each visit. If you are insured by a plan we do business with, but their system states your coverage is termed for any reason, payment in full for each visit is required until we can verify your coverage. Once coverage can be verified, claims will be resubmitted and upon receipt of payment, a refund will be issued to you.

Co-Payments/Co-insurance-Must be paid at time of service. This arrangement is part of  YOUR contract with YOUR insurance company. Failure on our part to collect the patient responsibility payment, at the time of service, can be considered fraud. If not paid at the time of service, a $5 processing fee will be charged.

Non-Covered Services-Our physicians believe that the following supplies and/or services are an important part of your child’s care and recommend that you receive these supplies and/or services in our office in order to provide your child with the best care possible.  School forms require some of these services.  Please be aware that some services you receive may be considered non-covered by your insurance carrier. You are obligated to pay the “patient responsibility” portion for these services. Each insurance carrier has hundreds of different insurance plans; therefore, knowing your benefits is YOUR responsibility. Please be aware our billing department is not responsible for knowing what YOUR specific plan will or will not cover. We have contracted with certain insurance carriers and must follow what is allotted on the patient’s Explanation of Benefits. Any patient responsibilities “write off” is considered fraud, therefore, if the Explanation of Benefits states a patient balance, we are obligated to collect that balance by law.  To help you in determining what a covered service is and what isn’t we suggest you call your insurance company directly.  For your convenience, below is a list of usual routine billing codes.  You, the parent are responsible for the payment therefore, it is your responsibility to inform us prior to the service if you believe your insurance will not cover it and you feel it is not necessary.

Suresight-92015       Cholesterol          -80061        Tympanometry    -92567        Glucose              -82948

Vision     -99173       Lead Test            -83655       Urinalysis              -81000

Hearing  -92587        Denver                -96110          CBC-                    -85025

Proof of Insurance-All patients must complete our patient insurance form at the time of appointment. A copy of your current insurance card must be on file before we submit claims to your carrier. It is your responsibility to notify us within 30 days with any change of insurance.

Claim Submission-We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claims is your responsibility whether or not your insurance company pays your claim. Your insurance benefits are contracted between you and your insurance company. WE ARE NOT a party to that contract. Insurance carriers will not accept any claims submitted after 90 days therefore, it is imperative we have accurate information prior to submitting your claim to avoid any delay. Secondary insurance-As a courtesy, we will submit to a secondary carrier.

Broken/Missed Appointments-If you are unable to keep your appointment, you must give us the courtesy of canceling at least 24 hours in advance. This gives us the opportunity to fill the schedule. Our Missed Appointment Fee is $25, which is a fraction of the overhead expense incurred.

Return Check-Our return check fee is $20, after two bounced checks patient is required to pay with cash only.

Motor Vehicle Accident Claims-Are covered by No-Fault Insurance. It is YOUR responsibility to notify the carrier involved and submit our bill to them. We will complete the NO FAULT CLAIM form once we receive it from your carrier. It is your responsibility to follow up with the insurance carrier if payment is not received within 45 days at which time will then be considered a Patient Balance.

Non-Payment:  It is our office policy that patient balances must be paid in full prior to scheduling any well appointments. If your account is 90 days past due, you will receive a letter stating that you have 10 days to pay our account in full. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and your immediate family members may be discharged from this practice for non-payment. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During the 30 day period, we will treat your child for sick care only.

Privacy: HIPPA rules are taken very seriously at Kids First Pediatrics. Parents fill out paperwork that gives us permission to release medical information to where they request us to. Other people are not allowed to get information or to bring a child in, if the parent or guardian does not give consent. Medical information is not allowed to be faxed without written consent.

 

Appointments

Pre booking: We do not pre book sick appointments. Sick appointments need to be made the day they want to be seen. We do pre book for rechecks, immunizations, well visits, pre surgical clearances, etc.

Walk-ins: The policy is that we do not accept walk-ins, unless it is an emergency. If someone does come in and there is room in the provider schedule, then we can fit that patient in at that time. We may ask you to come back later that day if we are unable to fit you into our schedule.

Adding siblings: Please do not request to add on another child when you come in for your appointment. If you feel you need another child to be seen please call ahead to see if we have time to add another child to your time slot or if we have to change your appointment in order to accommodate two patients. Also there is paperwork involved for all visits and it makes it difficult when we aren’t given any notice.

Call backs: When taking call backs, we advise the parent/patient on the phone that either the nurse or provider will call them back as soon as they can. We take a brief message of what the problem or question is so that the nurse or provider has an idea of what the situation is prior to returning the phone call.

Referrals: After a patient makes an appointment with a specialist and checks with their insurance company to see if a referral is needed, they then contact us with all necessary information at least 48 hours before their appointment. Information needed from patient is the specialists name, address, phone number, fax number, date of appointment, reason for visit, and provider ID number. When all information is obtained, we can then generate the referral.

After hours phone coverage: Every night after the office forwards the phone calls to the after-hours answering service, there is always an “on call” doctor that can be reached if you need to speak to one. If a patient must talk to a doctor during the evening hours, they can leave a message with the emergency line, where at that time the service will contact the on call doctor so that they can return the phone call to the parent. We share the after-hours with another practice, Kids Care, so the call you get could be from a doctor from that practice. They will relay any messages from our patients to the office the following morning. If you have a question for a nurse you will be directed to the St Charles help line 1-800-KIDS.

Specimen Drop off: If a parent is told to drop off a urine specimen, it is important to drop it off in the morning to get the most accurate results. First morning urine can also be refrigerated up to several hours if unable to drop off first thing in the morning. Having an abnormal urine analysis DOES NOT mean there is something wrong with your child. Sometimes the way the urine was collected, what time of day it was collected, and how long it was in a container before testing can affect the results of the urine analysis. If it comes back normal in our office no further testing is needed. If it comes back abnormal at all it will be sent to the lab for further testing. We will be able to sign off on any school forms once we have a normal urine.

School/camp form: If the school form is available at the time of the well visit, the form can be completed at the time.  If the form is to be completed at some point after the well visit, most forms can be completed within 5-7 business days during busy well season or 2-3 days any other time of year.  Please be aware that sports physical exams require a urinalysis. Results requiring follow up may delay completion of your form. If your child has had a problem with protein in their urine in the past, it is recommended that you collect a first urine specimen upon arising to bring in with you on the date of your visit. Urine can be stored for up to 4 hrs in the refrigerator. It is up to the parent to review the completed form and to submit it to those who’ve requested it. We can supply a generic Health form.  See our “forms” tab.

Please notify us if there is a deadline for the form to be completed and we will do our best to accommodate you.

Medical records request including immunization records: If a parent is requesting immunization records by fax they MUST give us a written consent to release that information. If you are unable to fax us consent we will only be able to mail them home or you can pick up a copy in the office.

New patients: Our panel is open to new patients.  Prior to booking a well visit as a new patient, we will need the child’s records from the previous physician.  You must complete a record release and have the records mailed to us prior to your well visit.

If your child has an HMO, the PCP will be verified prior to the visit.  One of our providers must be verified as the PCP.  When registering new patients, several things are needed, such as; name, date of birth, address, phone number, insurance ID number, etc. Whether it is a newborn or a child coming to the practice for the first time, there is paper work that needs to be filled out for HIPPA and billing purposes. The paperwork can either be given at the time of their visit, or can be found on the website under “forms.”