Young Pediatric. Appointment Policy
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- Curtis Thornton
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1 Young Pediatric Appointment Policy It is our intention to provide your children the best care possible at all times and to accommodate as many requests as is realistic and feasible. It is within this context that we ask you to take a few moments to review policies that affect the way services are provided. Arrive early. Please remember that all insurance requires that your insurance data be updated prior to each encounter. This usually takes a few minutes. If this is not done, your insurance may deny your claim. We do not want time spent on administrative requirements to limit your time with the doctor. Schedule an appointment by calling option #2. Walk-in patients are offered the first available appointment. There is a $ fee for this service, in addition to visit fee, and it is not covered by insurance. Schedule same-day appointments for ill visits. Appointments are used on a first-available appointment basis. Patients who arrive on time are seen at their appointment time. Patients who have arrived on time will be seen ahead of those who arrive late. If you arrive late, we may need to abbreviate or reschedule your child s visit. Call ahead if you are late or unable to make your appointment time. We will do all that we can to accommodate your child s appointment and to minimize the need to reschedule your appointment. Late arrivals (>15 minutes after scheduled appointment) will be offered the next available appointment. In these cases, a no-show charge for the lost appointment will apply. While we will do all that is possible to accommodate requests, the first-available appointment may or may not be on the day the appointment was missed. The no-show charge will be waived if you contact the office 24 hours before your appointment. Remember that appointments canceled more than 24 business hours prior to when they were scheduled do not incur a no-show fee.
2 Appointments for additional children should be made by phone prior to coming to the office. An additional $10.00 charge is applied for the add-on appointments. If you would like another child to be seen, please schedule appointments for both children by phone prior to coming to the office. Turn off cell phones in the office and examination rooms. After-hours Call Service Please limit after-hour calls to urgent issues and emergencies. For refills, appointment requests, and other non-urgent matters, you may leave a message or call the office during regular hours. Prescription requests left on voic after 4pm will be retrieved the next business day. Please also do the following when leaving a message: Please speak slowly. Be sure to leave a callback number. Disable your call block feature. Follow the doctor s instructions. We are here to provide the best care we can to your children should the need arise. As always, we welcome the opportunity to care for your children and appreciate your trust in the services we provide. Young Pediatric Staff Physician - Dr. Staci Young, Dr. Elizabeth Satterly Pediatric Nurse Practitioner - Allison Cosa Nurse & Office Manager - Denise Gray Triage - Jennifer MAs - Mendy, Angie, Lupe, Kim Reception - Libby Billing - Sher & Vicki
3 Young Pediatrics Health Form Policies It is the goal of the physicians and staff to accommodate as many requests as possible to the furthest reasonable extent, bearing in mind the following limitations: 1. Blank forms will not be accepted. Forms will only be accepted for completion if the patient s name and other information has been completed. In some cases we may not be able to complete or certify a form if parents have not completed their parts of the forms prior to form submission. 2. Turnaround time for form completion is usually fewer than 10 business days. While every effort will be made to complete forms as quickly as possible, parents should realize that at certain times of the year we may receive hundreds of health forms in one week, and remember that each of these has to be carefully reviewed by a physician before it is released. Parents are strongly advised not to wait until the last moment to look at the paperwork they have received from the program their child is scheduled to attend. 3. Forms will be held here for parents to pick up. Because of Health Insurance Portability and Accountability Act (HIPAA) regulations, forms will be released to parents only. Federal law prohibits doctors offices from faxing or mailing medical information to nonmedical facilities. We cannot be responsible for delays or losses in the mail. 4. Forms are completed for those whose accounts are in good standing. Delinquent accounts must be brought current before forms will be released. Forms must be paid for before they are released. 5. Many forms require the information to be based on an examination completed within 12 months of the date the form is completed. These requirements notwithstanding, no form will be completed for any patient who has not had a physical examination in our office in more than 12 months. 6. Forms are completed on the basis of examinations conducted by physicians in this medical group. Examinations performed by checkup
4 centers will not be cosigned by your physician, nor will he or she complete any forms based in whole or in part on any information provided by such centers. 7. Forms are completed based on information abstracted by staff from your child s chart. All forms are reviewed by a physician for completeness and accuracy. In some cases, forms mandate that only the physician may complete them. 8. There is no charge for Women, Infants, and Children (WIC) forms. 9. The minimum charge for review or completion of a non-wic form is $5 per form. Charges vary with duration of physician involvement and time. The physician completing the form determines the charge. The front office staff does not have the authority to alter, reduce, or change charges. 10. Insurance companies do not reimburse for form completion, and we do not bill insurance for completing any form.
5 YOUNG PEDIATRICS 4804 SOUTH STATE ROUTE 159 GLEN CARBON, IL BILLING PHONE FAX September 1, 2010 Co-pays Our office policies All co-pays are due at the time of service. If they are not received, they are subject to an extra $10 charge for extra billing procedures that will need to be performed. This charge is the responsibility of the patient, and will not be billed to the insurance company as the co-pay is the patient s responsibility. Collection Clause In the event the responsible party fails to pay pursuant to the terms of the contract Young Pediatrics reserves the right to pursue all available legal remedies pursuant to the laws of the State of Illinois. Should your claim be referred to a collection agency and/or attorney for collections, the customer will pay all necessary costs of collection, along with all legal fees with interest to be accrued at the annual rate of 10 % per annum. At this point, the relationship between provider and patient (entire family) will be terminated. Phone calls and letters are sent out as a courtesy prior to being handed over to the collection agency. If no response in the designated time frame, they are sent on. Monthly Payments Payments must be made at each visit, or at a minimum of regular monthly payments may be set up. Contact our billing office for details. Termination of professional relationship (entire family) will result with non payments. No Show Charges Patients will be responsible for the $25 no show/no call charge for not cancelling appointments 24 hours prior to the appointment. Termination of our professional relationship (entire family) will result of multiple no shows. See above about payments. Reminder calls are done as a courtesy when time permits, however, they are not MANDATORY and ultimately, it is your responsibility to keep track of your child s appointment. Return Check Fees There is a return check fee of $35 per check returned from your institution. This is necessary due to the fact we are charged by our financial institution. After checks have been returned, the family will then be placed on cash/credit or debit only for payments. Changes ANY changes of insurance, address or phone numbers must be given at the time of visit or prior by phone. Current insurance cards must be presented at each visit. If an insurance change is made, we must have all the information ID#; Group# & Billing mailing address (on back of card) as well as Parent carrying the insurance with their birth date & SS#. If multiple insurances, which is primary? We hope this information will help all our patients to prevent any poor experiences or confusion with your insurance company for you. We are dedicated to make the health of your child a priority and easy experience, while providing the best care for your child. Thank you for choosing Young Pediatrics. We are always willing to help with any questions you may have. UPDATED 3/1/2013
6 Young Pediatrics 4804 South State Route 159 Glen Carbon, Il PH: Fax: Appointment & Immunization Schedule Revised March 2013 Growth and Development are checked at each Well Child (WC) appointment Parents are responsible to make appointment for each age listed. 1 week WC apt only 1 month - Hepatitis B (dose #2-should have gotten dose hospital/birth) 2, 4, & 6 month - WC; Pentacel, Prevnar, and Rotorix (only 2 doses) *9 month - WC; Hepatits B Hgb and Lead (if needed) *12 month - WC; MMR, Varivax, Prevnar 15 month - WC; Daptacel (DTaP), ActHIB TB (if needed) *18 Month - WC; Hep A Hgb and Lead (if needed) *24 month - WC; Hep A *30 month - WC apt only At 3 years of age yearly WC and the following immunization schedule. 4-5 year - Kinrix, MMR, Varivax 6-10 years - WC apt only 11 year - Tdap, Menactra, Gardisil years - WC apt each year (Tdap booster and Menactra booster when needed) *Ages and Stages Questionnaire administered School Physicals are required for Kindergarten, 6 th and 9 th grades DHS Forms are required for all licensed Day Cares and Preschools and must be updated yearly Sports Physicals are required for 6 th grade and up who participate in a school athletic program Please call to schedule school and sports physicals at least 4 weeks prior to start of school/sport deadline.
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