PrimeCare Pediatrics requires that you provide all current health insurance information on every patient at the time of scheduling the appointment. Or in the absence of appropriate health insurance, to provide reasonable financial proof acceptable to PrimeCare Pediatrics. We may decline to make an appointment without this information. PrimeCare Pediatrics will verify coverage and confirm that PrimeCare Pediatrics or Dr. Tega is the primary care physician of record. The responsible party must inform PrimeCare Pediatrics of any changes in coverage for existing patients prior to scheduling an appointment. All current patient balances are to be paid prior to scheduling an appointment.
As part of the stipulation in our contracts with health insurance payers, PrimeCare Pediatrics is to collect appropriate co-pays from every patient/parent/responsible party at check in, prior to services being rendered. The responsible party will be required to show proof of current health insurance, by means of a health insurance card, for each patient at each visit. It is the policy of PrimeCare Pediatrics to collect the amount that is the patient’s responsibility, such as coinsurances, deductibles, non-covered procedures and tests at check out based on the insurance company allowable. Any non-Medicaid patient qualifying for “Vaccines for Children” must pay for immunizations given on the day of service at check out. Uninsured patients, or persons who are self-pay, are required to pay for all services on the day of service at check out.
It is the policy of PrimeCare Pediatrics to mail as few patient statements as possible, in an effort to reduce healthcare costs.
Coordination of benefits (COB):
The responsible party must respond to the request for information from the health insurance company within 10 business days. This is in the interest of the responsible party to facilitate the processing of any health insurance benefits on their account, and serves to prevent their account from becoming over-due or delinquent.
A failure to respond to a request for COB information from the health insurance company will result in all charges becoming the responsibility of the patient, and or responsible party.
Well Child Exams and Sick Visits:
In the event that your child comes in for a well child exam but other clinical issues are addressed in the same visit, the combined visit may generate a co-payment, per your insurance contract, for the sick portion of the visit. This co-payment will be due at the time of check out. In the event the other clinical issue requires a substantial amount of provider time to address, your well child exam may need to be postponed to another day. The separation of the visit will allow our providers to provide a thorough assessment of the new clinical issue.
Delinquent status: Collection Agency:
It is the policy of PrimeCare Pediatrics to mail as few patient statements as possible, in an effort to reduce healthcare costs. If a patient balance (due from patient) is incurred, responsible parties are encouraged to mail the payment directly to PrimeCare Pediatrics upon receiving the EOB (explanation of benefits) from their insurance company. It is the policy of PrimeCare Pediatrics to mail one statement in an effort to collect the patient due. If 30 days after the generation of the first statement it is necessary for PrimeCare Pediatrics to mail a second statement because no payment has been received, an interest charge of a flat 12% of the balance, but not less than $5, will be added to the account. If no payment is received 10 business days after the mail date of the third statement, the account will be reviewed and turned over to the collection agency. All accounts turned over to the collection agency will also be responsible for the collection agency fees.
No appointments will be made for any children of the responsible party while the account is in collections with the collection agency.