Our practice has experienced an increase in parents requesting to delay or decline vaccinations. This may be as result of celebrities claiming that vaccines harmed their children or as a result of the increase in the numbers of vaccines and injections in recent years. There is a larger number of parents that do want to immunize their children and are curious if they are families that do not immunize their children in our practice.
My colleagues and I as part of promoting preventive care are investing a significant amount of time educating our families, in vaccines use in children’s well child visits. In response to this demand of time and energy, we developed a vaccine policy:
These things being said, we recognize that there has been and will likely be controversy surrounding vaccination. The success of a healthy nation is based on prevention, is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given.
Because of vaccines many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis or even chickenpox, or known a friend or family member whose child died of one of these diseases, such success can make us complacent or even indifferent about vaccinating, but such an attitude, if it becomes widespread, can only lead to tragic results.
Furthermore, by not vaccinating your child you are taking a selfish advantage of thousands of others who do vaccine for children, which decrease the likelihood that your child contract one of these diseases. We feel such an attitude to be self-centered and unacceptable.
We are making you aware of these facts not to scare you, but to emphasize the importance of vaccinating your child. We recognize that the choice may be very emotional, but we recommend as healthcare providers is the right thing to do.
Finally, if you should absolutely refuse to vaccinate your child despite all our efforts, we respect your belief, however, we will ask you to find another health care provider who shares your views. We do not keep a list of such providers, nor would recommend any such physician.
Please recognize that by not vaccinating you are putting your child and our patients at unnecessary risk for life-threatening illness and disability and even death.
As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults.
Thank you for your time in reading this policy, and please feel free to discuss any questions of concerns you may have aboutvaccines with any of us.
The APC Pediatrics Team
Please read and initial the following statements:
By signing below, you agree to authorize the previous provider named above to disclose and release the records obtained for the evauluation and treatment of the patient listed above to APC Pediatrics.
By failing to sign below, you understand that you (parent/guardian) do not want the records to be released and therefore our office may have the right to cancel or postpone your appointment.
APC Pediatrics reserves the right to charge $20 for a hard copy of medical records for the first 20 pages and .25¢ for any page thereafter.
Authorized parents and legal guardians have access to their medical records through our secured patient portal at no cost.
There will be no charge for a records transfer directly to healthcare providers for coordination and/or transfer of medical care.
If at any time this adult/person above is no longer allowed to bring the patient into the office, it is the parent's responsibility to inform our office in writing that a parent is withdrawing this authorization.
Your Healthcare Benefits are a contract between you and the insurance company. We are not a party in that relationship. Not all healthcare plans are the same and not all policies within the same plan has the same coverage, having said that, parents may be responsible for non-covered services, out of pocket responsibility, copays, deductibles and coinsurances, these payments are expected at the time service is rendered and we will be collected from parents at check-in. We must emphasize that as a medical care provider, our relationship is with you and your child. We will coordinate all their medical needs, these services are performed to the patient not your insurance company, therefore the responsible party is the patient and you as the parent. We participate on the insurance networks by servicing their members. We agreed not to exceed charges allowed by your insurance and this is followed 100%, and as parent, we expect that you comply with the terms on this Financial Policy and to this financial responsibility.
We will be happy to bill your insurance for medical services, and we will accept their assignment, however we run eligibility before any new service and if it is determined that you have an un-met deductible, copays, coinsurance or any out of pocket responsibility, these payments will be collected prior to services. We will notify you via statement on any additional remaining responsibility (if there is any) and payment is expected in full upon received of the statement. Healthcare is no any different than paying for other services when they are due. Please remember these services were already rendered and payments areexpected as soon as you were made aware. For your convenience, We accept all major credit cards for payments, personal checks as well as online secure payments by visiting www.Apcpediatrics.com and selecting “online payment”. Feel free to notify APC pediatrics – Billing Department if you feel there should be a credit after claims were processed due or as a result of insurance retroactive coverage, patient regaining eligibility or the insurance covering more on your patient responsibility. We will be happy to refund you within 7 -14 business days from your notification and our confirmation that other payments were received.
For questions regarding your benefits, we encourage you to call directly to your insurance and get familiarized on the benefits, coverage, limitations, exclusions and out of pocket expenses. Now days, we are noticing an increase on different coverages where insurances company are sharing more the cost with patients in order to keep the monthly premium low and a more affordable rate to members, All these ultimately could result in more patient responsibility.
Referrals - If your insurance company requires a written authorization within the plan for any visit to the specialist, parents are responsible for obtaining this referral by calling APC Pediatrics, Referral/Authorization Dept to inform us on the visit with at least 36 hours prior to the appointment with the specialist, in order for APC Pediatrics to obtain the authorization from the Health plan and facilitate all medical records needed for further treatment. Parents, please note delay on requesting authorization could result on delays in care and appointment reschedule.
No Show/Cancellation – A fee of $20.00 will be assessed to the patient’s account if you missed or did not cancel the confirmed appointments. We appreciate at least 24 hrs cancellation notice.
Returned Checks- are subject to bank fees of $25 NSF (for insufficient funds).
Collection Agency – Services are DUE at the time of service, however for remaining and/or outstanding balances our office will mail statements to the Patient address on file and these balances are due upon received since services has been already rendered to your child. It is the parents solely responsibility to update address and patient demographic when changes takes place. We reserve the right to send uncollectable balances to Collection Agencies.
By signing this Financial Policy, I understood and agreed on the terms. I understand my Financial responsibility toward services rendered by APC Pediatrics, as well as I authorize the release of any medical information to the Insurance carriers and specialist/s including but not limited to, diagnoses, evaluations and treatments.