Professional Fees

Payment for professional services is required at the time service is rendered. Any other arrangements for reimbursement should be discussed with our office staff prior to your visit. Please feel free to ask our staff if we are a participating provider with your current or future health insurance plan. If you are a member of an HMO, PPO, or other “managed” health plan, you must present your insurance card and co-pay at each office visit. 

We are not a participating provider in Medicaid, Medicare or any other government health plan. Discounts are provided for indigent or uninsured patients, and interest is not charged for services not paid by third-party payers. However, there is a $25 late fee added to all unpaid balances over 60 days. Additionally, there is a service fee of $25 for any checks that are returned due to insufficient funds. Any questions or complaints pertaining to these billing practices should be directed to our billing office or office manager.

 

Health Insurance

For your convenience, we are an in-network provider for numerous PPO’s and HMO’s. If we have a contract with your insurance carrier, we will file medical claims directly with them. Our office will also file insurance claims for hospitalizations, including newborn care. Your newborn must be added to your insurance plan within the first 30 days, otherwise he/she will not have coverage until your next open insurance enrollment period and you will be responsible for all charges. We file primary insurance only, and no secondary insurance. Insurance claims are filed a maximum of twice, and then payment will be expected from the patient. In order to submit your claim, we must have a current copy of your insurance card on file. If you fail to make us aware of changes to your insurance carrier at the time of your visit, the responsibility for payment for the office visit and subsequent reimbursement from your new insurance carrier will be yours. All outstanding balances and co-pays will need to be paid before you can see the doctor at each office visit.

Please note that there are certain services and items that may not be reimbursed by your insurance carrier, but are the responsibility of the patient to pay. We will send you a bill for these items and prompt payment will be expected. 

Typical items the patient will be expected to pay include:

• Office visit co-pays
• Co-insurance payments for visits (example: 80%/20% insurance plans)
• All office visits prior to the unmet portion of the yearly deductible
• Office visits prior to insurance coverage or after coverage termination
• Any non-insurance covered service

Our contract with your carrier, and your agreement with your insurance provider require both of us to follow certain procedures when accessing specialists, or obtaining laboratory or x-ray services. The insurance plan may require use of specific laboratories, hospitals or x-ray facilities, and some plans may have restrictions on seeing specialists without prior approval. Also, not all PPO’s and HMO’s provide the same coverage for preventative health visits (check-ups), immunizations or laboratory tests. We strongly recommend that you contact your insurer prior to your first well visit to make sure that you know what visits and procedures will be covered.

 

Refill, Referral and Record Requests

Refill requests are generally completed within 48 hours. Sometimes these require insurance authorization which can take time, so refills should be called in sufficiently early so that your child does not run out of medication. Things to remember: We do not refill antibiotic prescriptions. Stimulant medications for ADHD cannot be refilled or mailed to your home, and must be picked up in our office per state law. We require yearly well-child exams in order to refill medications for those children with chronic medical conditions that require routine monitoring. 

Referral pre-authorization is required by certain insurance plans in order for your child to be seen by a specialist. We generally are unable to obtain same day referral authorization, and we cannot retroactively authorize visits for non-emergent specialist care. 

Transfer of medical records is sometimes necessary because of family relocation or insurance changes. We will be glad to provide a complete copy of your medical record after receiving a signed, written request as required by law. If we have records from prior physicians in our chart, we will also forward these if you specify their release in your request. All requests for medical records will be assessed a nominal fee, as specified by Texas Law. The Texas State Board of Medical Examiners requires us to provide the records within 15 days of receipt of payment, unless a medical emergency exists. For your convenience, we can usually provide a one-page summary (list of dates of service and diagnosis only) and immunization records within 48 hours at no charge.

 

Authorized Caretaker

Important:  Please notify the office of any changes in address or telephone numbers. Whenever leaving town, make certain that the person caring for your child has a notarized statement giving them authority to obtain medical care. If a patient is a minor (anyone under the age of 18), a parent or legal guardian must be in attendance to give consent for treatment and to be the responsible guarantor.