Financial Policies

 

When your child has a visit with one of our physicians or nurse practitioners, we want you to focus on your child's visit, not the finances involved. For this reason, we share our policies relating to insurance, payment, and billing. We are committed to having a successful physician/patient relationship and want you to be familiar with and understand the reasons why we handle billing and insurance the way we do. We hope that by providing our policies to you in advance, you will have a pleasant and efficient experience at the time of your visit.

Insurance plans:

The Federal Trade Commission (FTC) requires all medical offices to verify the identity of their patients, confirm the patient's address and telephone number and verify insurance coverage. This requirement is to prevent and detect identity, insurance or medical identity theft. Please tell us about every insurance plan covering your child. It is illegal to present insurance information that is not complete or not accurate.

Your insurance coverage is an agreement between you and your insurance company. Many health insurance plans are offered, all with different benefits. Learn what your insurance plan will and will not cover as we cannot know the details of every health plan. As a courtesy to our patients, Harrisonburg Pediatrics will bill insurance for medical services we provide.

 

Non-participating plans:

Harrisonburg Pediatrics is not a participating provider with all insurance carriers. In some circumstances, we participate with the insurance company but are not accepting new patients. Please contact your insurance company to see if we participate or are accepting new patients. Even if we do not participate with your insurance plan, we can still see your child. You will be financially responsible for any remaining balance owed after insurance payment.

We will work with you to get your claims paid; however, you are responsible to ensure that we have accurate information to submit your claim. For this reason, we request a copy of your insurance card(s) at every visit. We will need your child's full legal name, the policyholder's name, identification and group numbers, and the claims address, before your claim can be submitted to insurance. Check personal information listed on your insurance cards carefully for accuracy. Inaccurate or incomplete information will cause your insurance company to deny your claim for payment. Insurance payment will not be made until this information is corrected. Only you can contact your insurance plan to correct a misspelled name or wrong birth date. Insurance companies will pay for covered services if they are submitted or corrected within a specific time frame. Failure to act promptly to correct this information will result in out of pocket expenses for you.

Understanding your insurance benefits can be difficult. The practice and the patient must work together to ensure that the insurance company applies benefits accurately. If you contact an insurance company representative with questions, please obtain their first and last name plus the date and time of your call. Many times, conflicting information is given to the patient and to the practice. We will not be responsible for incorrect coverage or benefit information given to us by your insurance company.

Explanation of Benefits (EOB):

For every charge submitted, the insurance company mails an EOB statement to the policyholder and to the practice. This explains how a charge is processed and what the insurance company has paid to us under your plan benefits. Please review this document. This will inform you of amounts that you owe to the practice for a deductible or co-insurance. Please contact your insurance company, not the practice, if you have questions about the insurance coverage or payment.

Coordination of Benefits (COB):

At times, insurances may "hold" their payment of claims until they obtain information from you. You will receive notice of this payment delay from your insurance company. Only action from you, not the practice, can resolve this situation. If these requests for information are not addressed promptly, you will become responsible for the bill.

 

Office Charges:

Anytime your child sees one of our health care providers, charges will incur. Please ask about our fees for visits, labs, procedures, or immunizations before your visit. Once the service has been rendered, payment is expected and the charge will be submitted to insurance. If not covered by your insurance plan, charges will become your responsibility.

Well Child Checkups:

Your insurance plan may or may not cover charges associated with a well checkup, routine labs or procedures, and immunizations. Please contact your insurance company before your visit to learn about your well visit coverage.

Self-Pay Accounts:

Patients who do not have insurance, do not bring an updated insurance card, or have not met their deductible are considered self-pay accounts. Payment is expected at the time of service. Your signature will be requested on a waiver completed for the services being provided. Charges for the visit will be submitted to the insurance company on file. A refund will be issued to you if insurance covers the visit.

After Hours Charges:

Patients who are seen on weekends and on holidays are charged an additional fee. This fee may not be covered by all insurances. Fees not covered by insurance become your responsibility.

Services not covered by Insurance:

The office provides certain services that may not be covered by all insurance plans. After hours charges, charges to provide emergency services, charges for splints, slings, or ace wraps, certain immunizations, and charges relating to the Education & Counseling Center (ECC) may not be covered by insurance. Charges not covered by your insurance plan are your responsibility.

 

Payment:

Payment is expected at the time of service for all visits. Your appointment may be rescheduled if payment is not received. Insurance coverage can change frequently. To ensure we are submitting your visit correctly, a current insurance card is requested at every visit. Any balance due on your account will be collected in addition to your copay. We accept cash, check, Visa, MasterCard or Discover.

Co-pays:

Co-pays are due and payable at the time of service. Failure to pay your co-pay on the day of service will result in an additional fee to your account. Your agreement with your insurance company requires the payment of your co-pay at every visit. Our agreement with your insurance company requires us to collect a co-pay at every visit. We are required to report families who consistently fail to pay co-pays.

 

Returned Check Charges:

Additional charges will be added to your account if your check is returned for any reason. In many cases, the bank will also add fees for checks written on closed accounts or for insufficient funds. 

Missed Appointment Charges:

Whenever possible, our staff makes reminder telephone calls regarding upcoming, scheduled appointments. However, there are times when we are unable to do so. The responsibility to know that an appointment is scheduled will fall on you.

If you know you will be unable to keep a scheduled appointment, please call our office to cancel. If the appointment is not cancelled it will be considered a missed appointment. An additional fee will be added to your account when a missed appointment occurs.

Statements:

Statements are mailed monthly. Please review your statement carefully. It will tell you when charges are outstanding to insurance or are your responsibility. To avoid additional charges, please pay balances promptly. Please contact your insurance company, not the practice, if you have questions about the insurance coverage or payment. Please contact our billing staff if you have questions about the charge or your account balance.

Outstanding Account Balances:

You are expected to pay any outstanding balance within 2 weeks of the date of service. If statements have been mailed and you have not contacted the practice regarding your account, a collection fee will be added to your balance. In the event, your account is turned over to a collection agency, additional fees will be added to the account balance and your family will be asked to seek medical care elsewhere. Additional fees and action can be avoided by promptly paying outstanding balances or by calling our office to discuss the account balance.

Requests from 3rd party financial services:

We do not participate with outside financial companies who request us to accept payment for a portion of the balance owed.

Bankruptcy

Families, who file for bankruptcy and include the balance owed to the practice in with their filing, will be asked to seek medical care elsewhere.

 
 

Office Procedures:

Patient Information Sheets:

To ensure we have correct contact information in our computer, we ask you to complete a patient information sheet annually. If your demographic, insurance, or guarantor information changes sooner, you will be asked to complete additional forms to update this information.

Newborn Registration Form:

Parents are asked to complete a newborn registration form at their first visit. This provides insurance information so newborn charges can be submitted. Parent's must call the insurance company and add the newborn to the policy, usually within 30 days of the date of birth. If this is not done, your insurance may not pay for these charges and they will become your responsibility.

Referrals:

If your child has another physician listed as the Primary Care Physician (PCP), you may be required to provide an authorization from the PCP listed on your insurance card before services can be rendered in our office. If an authorization is not available, you will be asked to pay in full for the services or reschedule your appointment.

If we are your PCP, many insurance companies require us to obtain an authorization before sending you to see a specialist, for emergency room visits, or before special procedures can be ordered. Patients must be seen in our office before these referrals can be given. Harrisonburg Pediatrics cannot back date referrals in order to cover a visit that has already occurred. Referral guidelines are given to us by your insurance company and must be followed to ensure payment for these services. Check your insurance policy to learn what referral requirements are necessary for your family.

Child Custody Cases:

Harrisonburg Pediatrics cannot become involved in separation or divorce issues. Parents must work out an agreement for handling medical expenses. In the state of Virginia, both parents are responsible for paying for their child's medical care. The practice will bill the insurance company for services rendered. Remaining balances become the responsibility of both parents. Only one parent can be listed as the account guarantor. Statements will be mailed to this parent.

Young Adults:

At 18 years of age, patients become responsible for their own health and medical care bills as defined by the state of Virginia. Patients 18 years of age or older will complete a patient information sheet making them responsible for their account. Statements for any outstanding fees will be mailed to the patient. State laws prohibit us from discussing medical and financial information with the parent, even if they carry insurance on the patient, unless the patient gives permission and completes a release of information form.

Education & Counseling Center (ECC):

Mental health visits are handled differently than medical visits under most health insurance plans. Plans may not cover mental health services or may have in-network/out-of-network coverage. Frequently a co-pay, different than the co-pay paid for medical visits, is required at mental health visits. Please contact your insurance company to learn what mental health benefits your plan offers and to find a list of participating providers in your area. Our mental health providers do not participate with all insurance plans. We will obtain authorizations for patients being seen for ADHD or mental health services if we participate with the mental health plan. If we do not participate with your mental health plan, payment in full will be needed before your child can be seen. Obtain a copy of the bill to submit to your insurance if you have out of network benefits. If we refer your child to a mental health provider or counselor in the community, it is your responsibility to contact your insurance company for benefit information and authorization. Mental health can be a sensitive issue. Privacy requirements do not allow our practice to request an authorization for your child to see a provider/counselor outside of our office.

Harrisonburg Pediatric Billing Contact Information - 540-437-3750

Our billing employees spend most of their time talking with insurance companies or with patients. For this reason we ask you to call our billing telephone number and leave a message in voice mail. Voice mail messages are checked frequently. Billing employees make every effort to return telephone calls promptly. Often, we encounter a continuous ring, an answering machine, or a busy signal when we make return calls. If you do not hear from us, PLEASE contact our billing department a second time.