Kids GI Kare is committed to providing the highest quality health care for your child. As part of your relationship with Kids GI Kare a clear understanding of our financial policy is important so you will know what actions Kids GI Kare will be undertaking on your behalf as well as what your financial responsibilities
Your health Insurance policy is a contract between you and the insurance company. Kids GI Kare, as a courtesy to you, will bill your primary company for all services rendered, with the information you have provided us. You have certain responsibilities to ensure that proper, accurate and timely submission of charges occurs. You are required to present your primary insurance card at the time of service, and to Inform us as soon as possible of any changes of your carrier or policy information. Any unpaid claims because of wrong given Information will be the patient's responsibility. You are responsible to be familiar with your plan benefits, whether it is a copay or a deductible plan, and what services it covers. You are responsible for payment of all services provided by your pediatrician. Co-payment for services, in accordance with your insurance benefits, is due at the time of service.
Remaining Balance After Your Insurance Company has pain): Kids GI Kare will submit a claim to your primary health Insurance company for services provided. Any balance remaining following adjudication of this claim is your responsibility. This balance may include your deductible, coinsurance and any, and all charges not covered by your insurance company. Payment for this balance is due upon receipt of your billing statement. In the event a bill goes unpaid without contacting our billing department to discuss payment option, the account will be turned over to a collection agency. No Show Policy:
Each time a patient misses an appointment without providing proper notice, another patient is prevented from receiving care. Therefore, Kids GI Kare reserves the right to charge a fee of $ 50.00 for all missed appointments that are not cancelled with a 24-hour advance notice. Multiple "no shows" in any 12 months period may result in termination from our practice.
Request for Medical Records: $25 All daycare/school forms, to include school letters and all other forms If not filled out at the time of exam, will acquire a fee of $10.00. Returned checks: $30 After hours, weekend, and holiday appointments - $20.
Ihave read the above financial policy for Kids Kare Pediatrics and I agree to the terms listed above.