Financial Policy

Welcome to our office and thank you for choosing JDC Pediatrics for your pediatric care. Our goal is to provide you with the highest quality medical care. We have developed this financial policy because we believe that your clear understanding of our policy is very important to our professional relationship.

It is your responsibility to know the limits and coverage of your particular health insurance policy and to show your cards to us at each visit. We will make clinical recommendations that we think are in your best interest, but we cannot guarantee that your policy will cover any and all charges incurred. If you have a copay, it is expected to be paid at the time of service. If you are unable to comply, a billing surcharge will be added to your account. We participate with most major insurances. If we do not participate with yours, we expect payment at the time of service. We will be happy to file your claim for services if you have given us all the required and correct information. Regardless of participation, we will not become involved in disputes between you and your insurance company regarding deductibles, copays, covered/non-covered charges, etc, other than to provide factual information as necessary. If both parents carry health insurance for the patient, the parent whose birth date falls first in the calendar year is most often the primary insurer. Please check your insurance companies to determine which policy is primary before your appointment. If you have any questions regarding the payment allowance by your insurance company, our billing team will be happy to discuss it with you.

If there is a balance on your account, a billing statement will be sent to you monthly. Payment is due in full upon receipt of the billing statement. A $5.00 rebilling fee will be assessed for each additional billing statement that is necessary until your balance is paid in full. If you have an overdue balance on your account, we will not schedule routine care appointments until the balance is paid in full. If your account becomes 90 days delinquent, we will begin collection proceedings and a 33% additional fee will be added to your account to cover collections costs and your protected health information may be disclosed during collection proceedings. To avoid collections, you may set up an approved budget plan with our billing office. We accept cash, personal checks, VISA and MasterCard. If your personal check is returned unpaid from your bank, a $20 returned check fee will be added to your account.

For well child check-ups and other missed appointments, a missed appointment fee of $50 will be charged to your account.

The parent/legal guardian/authorized adult accompanying the minor child is responsible for payment, regardless of legal or custodial arrangements. We do not get involved in financial disputes between parents; the parent who brings the patient for services is expected to pay copays and non-covered services at the time of service. Subsequently, bills will be sent to the address of record and the parent who lives at that address will be responsible for payment. Any patient 18 years or over is legally an adult and will be responsible for his/her bill, regardless of attending college, living at home, or being covered by parents' insurance.

If you need URGENT medical advice overnight (between the hours of 10 PM and 8 AM Monday through Saturday and 8 PM and 8 AM on Sunday), you are welcome to call our office. You will reach our nurse triage service and a nurse will evaluate your URGENT call and refer you to our physician on call if necessary. Because JDC Pediatrics is charged for each call made to this service, effective August 1, 2007, a service charge of $20.00 per call will be added to your account.

I have read the JDC Pediatrics financial policy above and agree to its terms. I understand that I am financially responsible for all charges whether or not covered by my insurance. I authorize the release of any medical or other information necessary to process our claims and I irrevocably assign JDC Pediatrics payment for services rendered.

revised 5/5/10

*RECEPTIONIST WILL HAVE YOU SIGN OUR ELECTRONIC SIGNATURE PAD*