Thank you for choosing First Choice Pediatrics as your health care provider. Please understand that payment of your bill is considered a part of your child’s care. The following is a statement of our Financial Policy, which we require you to read and sign prior to treatment.

• Due to frequent changes in health insurance, we require that you provide proof of insurance coverage for your first visit and if you change insurances. If you do not have insurance, or if we are unable to verify your insurance coverage or are on a plan in which we do not participate, a full payment is required at the time of your visit.
• The parent/guardian is responsible for payment of all fees. Please discuss any financial problems with us to avoid any misunderstandings or call our office and ask for the billing department at 407-249-1234
• All co-payments and deductibles are due at the time of service. These fees cannot be waived. For your convenience, we accept cash, Visa/Master Card (including debit cards).

Non-Contractual Insurance

• For insurances with which we do not have a contractual relationship with, you will be responsible for your entire bill at the time of service.

Contractual Insurance

• Please be aware that some of these services may be non-covered services and not considered reimbursable under your insurance plan. You are personally responsible for these services.
• We will routinely file your insurance claim for each visit. Should there be a dispute with your insurance we will attempt to resolve it on your behalf. Your insurance policy is a contract between you and your insurance company: therefore, your balance is your responsibility.
• It is our company policy to only bill primary insurance. Any deductible, coinsurance, copayments and uncovered charges applied to your account by your primary insurance will be your responsibility.

Vaccines for Children (VFC) Program

• Children who are not insured or are American Indian or Native Alaskan qualify for the Vaccines for Children program. The vaccines are provided free of charge, but there is an administration fee, which is your responsibility. If your child qualifies and you would like to participate in the VFC program, it is required that the nurse be told at the beginning of your child’s visit as cannot implement this program retroactively. The administration fee is $24.00 for each vaccine.

Administrative Fee

• Participation forms such as camp, school, sports, and WIC might be subject to a processing fee. Shot and physical forms will be processed without charge if done at the time of the well visit. Any further request for a shot and physical forms will be charged a $3.00 fee each payable at the time of pickup. You must allow for 3-5 business days.

Delinquent Accounts

• If there is an outstanding balance on your account, a payment plan may be arranged with our billing department prior to your visit. Failure to resolve any past due accounts will result in referral to a collection agency.

Transferring of Medical Records

• Since there are frequent changes in health insurances coverage and participating providers, it is often necessary for patients to ask that their medical records be transferred to another physician’s office. An immunization record, growth chart, and problem list can be faxed to another physician’s office at no charge, with a completed medical release form signed by the parent/guardian. FCP is the owner of you/your child’s medical records. However, you are the legal guardian of your records and may request their release at any time with proper documentation. To obtain a copy, the fee is $1.00 per page and $0.25 after 25 pages. Allow 2 weeks for processing.

Patient Behavior

• Patient(s) must respect First Choice Pediatrics employees as well as other patients.
• Patient(s) must adhere to all office and financial policies.
• Absolutely no photography or recording is allowed on the premises of any First Choice Pediatrics facilities.
• No food, cell phones, profanity or smoking is permitted at any First Choice Pediatric office.
• **All patients are asked to please check out before leaving the office. It is unlawful to intentionally walk out without satisfying your financial obligations after treatment has been rendered.

New Patients

• We ask all new patients to please arrive at least thirty minutes in advance to fill out all new patient paperwork. Picture ID of a legal guardian and Insurance ID card are required before any service is provided. New patients must also bring or have sent, all relevant paperwork from your previous pediatrician, including immunization records, laboratory results, medication history, and all other medical records. All patients under the age of 18 years must be accompanied by a parent or legal guardian. A photo of every patient will be captured electronically and attached to patient chart and used for clinical identification only.

Scheduling and Appointments

• Due to frequent changes in health insurance coverage and personal demographics you must be prepared to show us your insurance card and ID upon arrival for each visit.
• Patients are seen by appointment only. We realize that children sometimes need immediate attention if this is the case; you must call our office prior to arrival.
• Since well visits take more time in our schedule than sick visits, they must be scheduled separately. If your child is scheduled for a sick appointment, please do not ask us to perform a well check-up during the same visit, as we will not be able to do so unless clinically approved by a physician.
• We also ask that no more than two siblings be scheduled at the same time, as our appointment schedule will not allow for more; however, we will make exceptions for triplets.

Late Policy/Walk-in Appointments

• We are always looking for ways to improve our practice and provide high-quality health care to your children while also trying to make sure your waiting time is kept to a minimum. Therefore, it is imperative you arrive on-time for all your scheduled appointments. In the event, you are late for your appointment, we may have to reschedule depending on the schedule for that day. We are always looking for ways to improve our practice and provide high-quality health care to your children while also trying to make sure your waiting time is kept to a minimum. Therefore, when you arrive 15 minutes late for your child’s appointment, it is considered as missed. However, our front office staff will first converse with your doctor and determine whether or not your child will be seen based on the current patient load. You may be worked into the schedule with a wait or you may be asked to reschedule, especially if it is a visit that requires a significant amount of the physician’s time (i.e. well check, evaluations, and new patient visits.) We are always trying our best to balance your needs with the needs of our other patients, please be mindful of this. This is why it is imperative you arrive on time for your appointment. You may be worked into the schedule with a wait or you may be asked to reschedule, especially if it is a visit that requires a significant amount of the physician’s time (i.e. well check, evaluations, and new patient visits.) We are always trying our best to balance your needs with the needs of our other patients, please be mindful of this. This is why it is imperative you arrive on time for your appointment.

Missed Appointment

• Your appointment time is reserved especially for you. In the event of a missed appointment or an appointment canceled with less than 24 hours’ notice, you might be charged a rescheduling fee. Insurance does not pay for a missed appointment.

Cancellations

• If you are unable to keep your appointment, you must notify our office at least 24 hours in advance so that another patient may be given this time. If not, as stated previously a rescheduling fee might be charged to your account.

Prescription Refills

• You may place a prescription request anytime through the Patient Portal. If you have any issues, please contact our office during normal office hours, and have your child’s name, date of birth, medication and pharmacy telephone number available when you call so we may assist you more efficiently. YOU MUST ALLOW FOR 3 BUSINESS DAYS FOR THE DOCTORS TO REVIEW YOUR CHILD’S CHART AND PROCESS THE SCRIPT SINCE IT IS NOT A SCHEDULED VISIT.

After Hours Care

• IF YOU HAVE AN EMERGENCY DIAL 911. If you need to see a physician after hours you must report to a local urgent care center. In the event you MUST speak to a physician after our hours of operation and cannot wait until the next business day, you may call our office at 407-249-1234 and our answering service will instruct you further as to how to get in touch with one of our physicians. 

Referrals

• For all non-emergency referrals, please contact our office at least one week in advance. In the event your child may need to see a specialist, your HMO or POS insurance company requires that you be referred by one of our primary care physicians (PCP). If we have referred your child to a specialist and their office requires authorization from your insurance company, you must contact us one week in advance so we can obtain authorization. If you have been admitted to the emergency room and a physician has instructed you to see a specialist, the first appointment should be made with one of our physicians to ensure proper documentation will start the referral process and proper care is provided. For any information about your referral, please refer to the Patient Portal.