AT TIME OF APPOINTMENT:
TO PROPERLY BILL INSURANCE FOR EACH VISIT, WE ASK THAT YOU PRESENT THE FOLLOWING DOCUMENTS TO THE RECEPTIONIST UPON ARRIVAL TO ALL APPOINTMENTS:
- INSURANCE CARD
- PHOTO ID FOR ADDRESS VERIFICATION
- ANY CHANGES IN DEMOGRAPHICS (I.E. PHONE NUMBER, ADDRESS)
IF YOU DO NOT HAVE THE CHILD’S INSURANCE CARD AT THE TIME OF THE APPOINTMENT, YOU WILL BE CONSIDERED A SELF-PAYING PATIENT AND MUST PAY FOR THE APPOINTMENT.
THESE CHARGES WOULD BE AS FOLLOWING:
- ANNUAL PHYSICAL WOULD BE $150 PLUS AN ADDITIONAL $20 PER VACCINE.
- ACUTE (SICK) VISITS WOULD BE $110.
COPAYMENT/DEDUCTIBLES:
ALL COPAYS AND DEDUCTIBLES ARE DUE AT THE TIME OF SERVICE. IF YOU HAVE ANY QUESTIONS REGARDING THE PAYMENT ALLOWANCE BY YOUR INSURANCE COMPANY, PLEASE CONTACT THE INSURANCE COMPANY DIRECTLY BEFORE THE VISIT.
PATIENT BALANCE:
MANCHESTER PEDIATRICS WILL SUBMIT CLAIMS TO YOUR INSURANCE COMPANY BASED ON THE SERVICES YOU RECEIVED. YOU MUST PRESENT PRIMARY AND SECONDARY INSURANCE CARDS, AS WELL AS ANY CHANGES TO CONTACT INFORMATION AT THE TIME OF YOUR VISIT TO ENSURE PROPER BILLING. IF WE ARE UNABLE TO SUCCESSFULLY SEND A CLAIM, YOU WILL BE CHARGED FOR THE OPEN BALANCE ON THE PATIENT’S ACCOUNT. FOR ANY VACCINATIONS PROVIDED OUTSIDE OF A WELL CHILD VISIT, YOU MAY BE CHARGED A COPAY PER YOUR INSURANCE POLICY. ALL COPAYS ARE DUE AT CHECK-IN.
IF YOU HAVE AN OPEN BALANCE, PAYMENT WILL BE REQUIRED BY THE NEXT APPOINTMENT’S CHECK IN. TO SCHEDULE A YEARLY PHYSICAL, ANY UNPAID BALANCE MUST BE PAID BEFORE THE APPOINTMENT IS BOOKED. IF YOU HAVE AN OPEN BALANCE OF $200 OR MORE OR HAVE RECEIVED THREE STATEMENTS WITHOUT PAYMENT, WE RESERVE THE RIGHT TO DISCHARGE YOU FROM THE PRACTICE. IF YOU CANNOT MAKE PAYMENT AT THE TIME OF YOUR APPOINTMENT, WE REQUIRE PAYMENT WITHIN 14 CALENDAR DAYS FROM YOUR APPOINTMENT