Insurance: As a courtesy to our patients, we will file the forms necessary so that you receive the full benefits of your medical coverage. It is your responsibility to provide Pelican Pediatrics with your updated insurance and if applicable, secondary insurance. We ask that you read your insurance policy to be fully aware of any limitations of the benefits provided. If your insurance company denies coverage, or we otherwise do not receive payment 60 days from filing your claim, the amount will then become due and payable by you. Remember that your coverage is a contract between you and your insurance company and/or your employer and your insurance company. Although we will make a good faith effort to assist you in obtaining your benefits, we cannot force your insurance company to pay for the services we have provided to you.
NEWBORNS: Most insurance plans require that a newborn be added to the parent's insurance plan within the first 60 days of life. It is your responsibility to contact your insurance company and have your baby added to the plan. If your baby is not added in a timely manner, you will be responsible to pay for any services incurred prior to the insurance becoming active.
Copayments and Deductibles: Depending on your insurance policy, a copayment and/or deductible or coinsurance may be required at the time of service. Please note that the copayment is a contractual requirement from the insurance company and cannot be written off by the clinic. If you participate in a High Deductible Health Plan (HDHP) and have not yet paid your deductible in full, it is likely that any non-preventive services will require payment at the time those services are rendered. Coinsurance may apply even after meeting your deductible.
Patients Without Insurance/Non-covered expenses: For patients without insurance a time of service discount will be applied to the bill if settled in full on the day of service. This discount does not apply after the day of the visit. The same discount will be applied to any noncovered charges for patients with insurance, if paid at the time of service. There may be charges that are not collected of billed that for extra tests and procedures that you will be billed for and expected to pay.
Financial Hardship: Because we realize that every person's financial situation is different. If you are uninsured and unable to pay the reduced self-pay rate, please contact the office administrative staff for an application to see if you qualify for our sliding scale based on financial need.
Medicaid: Pelican Pediatrics accepts all forms of SC Medicaid. It is your responsibility to make sure you do your child's annual renewal so that your child's Medicaid doesn't lapse or you may be responsible for services rendered. It is also your responsibility to notify Pelican Pediatrics if your child has other insurance in addition to Medicaid at the time of service or you may be responsible for services rendered. Returned checks: will be subject to a $35 returned check fec.
Patient/Parent/Guardian Responsibility: I understand that whomever accompanies my child to their appointment has authorization to consent to medical care as needed, and is responsible for payment of medical services. I acknowledge my responsibility for payment of all services provided by Pelican Pediatrics in accordance with the practice's fees and terms. In the cases where a custody plan exists, the parent that brings the child in for the appointment is considered the guarantor and is responsible for payment.
Late Fees: I understand that my account becomes delinquent if not paid within 30 days. Any delinquency post 90 days will warrant the balance and any administrative fees being assigned to a collection agency.
Assignment and Release: I authorize payment to be made directly to Pelican Pediatrics by my insurance company, and I accept financial responsibility for all services not covered by my insurance. I authorize release of any medical care information requested by my insurance company. I agree to abide by the Pelican Pediatrics financial policy: