|2009 |Joliet Pediatrics Financial Office Policy |
|By Candace Sanchez |[pic] |
|Axia College of University | |
|Of Phoenix | |
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Thank you for choosing our practice! Here at Joliet Pediatrics we are committed to the success of your medical treatment and care. Your understanding of our financial policy is an essential element of your care and service. Please understand that payment of your bill is part of this treatment and care.

“All charges you incur are your responsibility regardless of your insurance coverage. We must emphasize that as your medical care provider, our relationship is with you, our patient, not with your insurance company. Your insurance policy is a contract between you, your employer, and the insurance company. Our office is not a party to that contract.” (Brown & Kushner DDS)

Full payment is due at the time of service. If you have insurance and the insurance payment is not received within 60 days from the date of service, you will be expected to pay the balance in full.

As a courtesy to you we will help you process your insurance claims. “It is your responsibility to know the details of your particular insurance policy. Not all services are covered by all carriers.” (Turtle Creek Medical Financial Policy) Services which are not covered by your insurance are your responsibility.

Diagnoses and services are carefully documented to comply with federal law. Under no circumstances will these be changed, altered, or falsified in order to obtain coverage by insurance.

For your convenience, we have answered a variety of common asked financial and office policy questions below. If you need further information about any of these policies, please ask to speak to the billing manager.

How may I pay?

We accept payment by cash, check, VISA, MasterCard and Discover.

What if my account becomes delinquent?

Delinquent accounts will be sent to our collection agency for recovery. If your account is sent to our collection agency, you will be responsible for all fees incurred from the collection agency.

What if I write a check that is returned to your office unpaid?

Our returned check fee is $25.00. If more than one returned check is received on your account, we will require that future payments be made in cash or credit card. If you do not bring in payment for the check and returned check fee the check will be filed with the District Attorney’s office for collection. All fees incurred in the filing will be your responsibility as well.

What happens if I am late to my appointment or I fail to show up?

We recognize that patients may need to cancel or change an appointment but request that they provide at least 24 hours notice so we may offer their appointment time to another patient.

If you arrive over 15 minutes late to your appointment you may be asked to reschedule as this delay affects not only the physician, but other patients that are scheduled after you.

There will be a $25.00 charge for NO SHOW patients or patients who cancel their appointment less than 24 hours in advance, as these appointment times could have been given to a patient(s) in need.

Is there a sliding scale or low income payment plan available?

Unfortunately, here at our clinic we do not have one at this time. If this type of plan is what you need, you may want to visit your local health department or government agency.

What if I need a prescription refilled?

If you are calling in a prescription refill you must contact your pharmacy unless the prescription is one which by law must be picked up from our office. Only prescription refill requests from a pharmacy will be honored. You must allow at least 24 hours for all refill requests to be processed.

What if my child needs to see the physician?

A parent or legal guardian must accompany patients who are minors on the patient’s first visit. This accompanying adult is responsible for payment of the account, according to the policy outlined above.

Please remember that when you receive our statements you have already received quality care from our physicians and your insurance has been filed by us. We would then ask that you pay promptly upon receiving your statement.

Please feel free to contact our business office if you have any questions regarding your statement or insurance. We are happy to answer your questions or to provide additional information.

I have read, understand, and agree to the above Financial/Office Policy. I understand the charges not covered by my insurance company, as well as applicable copayments and deductibles, are my responsibility.

I authorize my insurance benefits to be paid directly to Joliet Pediatrics.

I authorize Joliet Pediatrics to release pertinent medical information to my insurance company when requested, or to facilitate payment of a claim.

__________ ____________________ ________________

Date Signature Printed Name

The reason why I believe our financial policy is best suited for Joliet Pediatrics is because our patients will be formally advised of our payments terms. This in turn, will help prevent excuses such as, “I didn’t know I had to pay today.” (PCC 1995-2006) We want the patients to know that we are serious about receiving payment in full and on time.

Having a consistent approach will help our staff be more effective when dealing with patients. If staff people are telling the same patient two different things this will create room for excuses and will eventually lead to late payments, write-offs and lots of headaches.

Having these written guidelines will help our staff have confidence when dealing with potentially delicate situations. It will also give our staff more control over the collections process.

Having a formal set of procedures will save time and prevent confusion each time a staff person confronts a difficult payment issue for the first time.

My staff understands that their salaries are linked to the financial success of the practice and that, through their collection efforts; they can have a significant impact on both.

Having a proactive approach in identifying and resolving potential collection problems before it is too late will help us collect more money faster and with much less hassle.

In order to ensure that our financial policy is successful, we will discuss the policy in more detail with patients such as copayments and secondary insurance. The patient’s personal information, for example; divorced or working parents, will help make our staff aware that the parent bringing the child in for the medical visit will be responsible for making the payment at the time of service.

We will also take the time to discuss with families expecting a baby or facing other major medical issues the extra costs of services. First time parents, especially, may not realize how many check-ups and immunizations their baby will need.

In order to help patients realize this we will give them a handout listing the appointments needed during the first year, along with the associated costs. This will encourage patients to plan ahead or make arrangements for a payment plan with our office. This is why we offer cash, check, and credit payments to help facilitate payment from the patient.

By explaining the delinquent account process up front in our Financial Office Policy, the patient is totally aware of what will happen if their account becomes delinquent.

The returned check charge is also plainly stated as well as the consequences of not paying the returned check and returned check fee. The District Attorney fees as well would be the patient’s responsibility as is stated in the policy.

Late appointment penalties are clearly defined in the policy. Canceling appointments less than 24 hours in advance will result in a $25.00 charge. A “NO SHOW” receives the same fee. This allows the practice to receive payment for the time wasted that could have been given to another patient in need, if the patient with the scheduled appointment had called and canceled within the 24 hour period.

The sliding scale or low income payment plan policy is discussed and is not available in this practice at this time. Suggestions of a government facility are given for the benefit of the patient.

Prescription refill service is clearly defined and only pharmacy requests will be honored unless the medication is distributed by us. (I.e. samples).

Many minor patients do try to be seen without their parents so it is imperative that they as well as their parents understand we cannot see them without their parent with them.

Finally, because we do care about our patients, we have drawn up this policy so that our patients will know in advance of the regulations of our practice. This information given helps both us the provider and the patient.

References:

“Pediatric Software Just Got Smarter, Your Practice Just Got Healthier” Physicians Computer Company (1995-2006). www.pcc.com

Turtle Creek Medical Financial Policy www.turtlecreekmedical.com

Charles D Brown, DDS & Gerald Kushner DDS, Cosmetic & CAD/CAM Dentistry • Implant Dentistry • Sleep Apnea • TMJ Disorders • Sports Dentistry 16100 Sand Canyon Avenue, Suite 380 Irvine, CA 92618 • Phone: (949) 833-8020 • Fax: (949) 833-3862 www.brownkushner.com