Our goal is to provide and maintain a good physician-patient relationship. Letting you know in advance of our office policy allows for clearer communication lessening any future misunderstanding. Please read each section carefully. If you have any questions, do not hesitate to ask a member of our staff.
1) We value the time we have set aside to see and treat your child. If you are not able to keep an appointment, we would appreciate 24-hour notice. There is a charge of $25 for missed appointments.
2) If you are late for your appointment (greater than 15 minutes), we will do our best to accommodate you. However, on certain days it may be necessary to reschedule your appointment.
3) We strive to minimize any wait time; however, emergencies do occur and will take priority over a scheduled visit. We appreciate your understanding.
4) Before making an annual physical appointment, check with your insurance company as to whether the visit will be covered as a healthy (well-child) visit. Also, after age 2 annual physicals must be scheduled 365 days from the last physical.
1) For monthly medication refills, we require 48 hours′s notice to complete the prescription for pickup/faxing/calling into the pharmacy. Please plan accordingly. ADHD medications must be picked up at the office and cannot be called / faxed to pharmacy.
1) It is your responsibility to keep us updated with your correct insurance information. If the insurance company you designate is incorrect, you will be responsible for payment of the visit and to submit the charges to the correct plan for reimbursement.
2) If you are enrolled in a ″managed care″ plan, (i.e. Carolina Access Medicaid, Tricare Prime, etc) we must be registered as your Primary Care Physician (PCP) in order to treat your child, unless you pay the out-of-pocket expense associated with the visit. That out-of-pocket will be collected at the time of service.
3) It is your responsibility to understand your benefit plan with regard to covered services and participating laboratories.
4) It is your responsibility to know if a written referral or authorization is required to see specialists, whether preauthorization is required prior to a procedure, and what services are covered.
1) According to your insurance plan, you are responsible for any and all co-payments, deductibles, and coinsurances.
2) Co-payments are due at the time of service.
3) Self-pay patients are expected to pay for services in FULL at the time of the visit.
4) If we do not participate in your insurance plan, payment in full is expected from you at the time of your visit. We will supply you with an invoice that you can submit to your insurance for reimbursement.
5) Patient balances are billed immediately on receipt of your insurance plan″s explanation of benefits. Your remittance is due within 10 business days of your receipt of your bill.
6) Any balance outstanding longer than 40 days will be forwarded to a collection agency.
7) For scheduled appointments, prior balances must be paid prior to the visit.
8) We accept cash, checks, Visa, and MasterCard credit and debit.
9) A $25 fee will be charged for any checks returned for insufficient funds.
1) Advance notice is needed for all non-emergent referrals, typically 3 to 5 business days.
2) It is your responsibility to know if a selected specialist participates in your plan.
3) Remember, we must approve referrals before they are issued.
1) There is no charge for a physical form when completed at the time of the visit. This is considered part of the visit. However, should you lose your form or need them completed after a visit; there will be a $10 charge per form.
2) Any additional school, camp, or sports forms are subject to a $10-per-form fee. Tricare/DD forms and Family and Medical Leave Act forms are $25. Payment is due when the forms are dropped off.
Transfer of Records
1) If you transfer to another physician, we will provide a copy of your immunization record and your last visit to your physician, free of charge, as a courtesy to you. We need 48 hours' notice.
2) A copy of the medical record is available. If you wish to obtain a personal copy see the following NC statute for copies of records.