BASIC POLICY: Payment for service is due in full at the time service is provided in our office. INSURANCE: As a courtesy, we will bill your insurance carrier for you if proper paperwork is provided to us. Co-payments and deductibles are due in full at the time of service. Your insurance policy is a contract between you and the company. The agreement is a private one and we are not a party to your contract. If you do not inform us of any special requirement or guidelines in your contract and we subsequently order services not covered, we will have no choice but to bill you directly. We do not routinely research why an insurance carrier has not paid or why it paid less than anticipated for care provided. If an insurance carrier has not paid within 60 DAYS of billing, the amount due will be your responsibility and will be payable in full by you. If your insurance carrier changes, you must notify us immediately. If insurance information is not provided within 30 DAYS of office visit, you will be responsible for any visits during that time frame.

COVERED SERVICES: Please check with your insurance carrier what are the services covered in your policy and also, make sure that our physician (Dr. Cely) is a provider in your health plan. In addition, please learn the process that your in·surance requires to obtain authorization for services. Some insurance companies require referral from your pediatrician; others require that you have your primary physician call the insurance company to obtain prior authorization by phone. Once you have obtained authorization or referral from your primary care physician. Be aware that every plan has different co-pay plans according to the number of visits authorized and also, some insurance require that you obtain an authorization once you have used your first set of authorized visits.

NON-COVERED SERVICES: Some of the services we provide may be non-covered or are not considered reasonable and necessary under you policy, but have been deemed to be in the best interest by your physician. If this is your case, we will need you to check with your insurance company prior to administering the test. You will have the option of declining or pay the test in full at the time of service. A list of billing codes are available upon request.

PAYMENTS: If you have a balance due on your account, you will receive statements from our corporate billing office. The letter you receive from your insurance carrier, (EOB) Explanation Of Benefits, will show the amount they covered and what portion is your responsibility. Our billing office will send three statements before turning your account over to collections. Your child will not be able to be seen until that collections balance is paid. Please remember that when you receive our statement, you have already received quality care from our physician. Prompt payment upon receiving your statement is appreciated.

MINOR PATIENTS: The adult accompanying the child is responsible for full payment. If a balance is due at anytime, it is your responsibility to pay that balance. In case of divorced parents, legal payment arrangements must be worked out prior to appointment.

MISSED APPOINTMENTS: In fairness to other patients and the providers, we require at least 24 HOUR notice to cancel appointments. You will be charged a fee of $100.00 if you fail to keep your appointment or do not give the necessary 24 hour notice. Insurance companies do not pay for missed appointments, so you will be responsible to pay this before your child can be seen again. Patients who repeatedly miss 3 appointments without notice will be dismissed.