Immunizations: Redbud Pediatrics vaccinates all children on the schedule recommended by the Center for Disease Control and Prevention and the American Academy of Pediatrics. This means that we do not split up vaccines or do a slow schedule of vaccinations. By signing below acknowledge that I have read this document and plan to immunize my children accordingly.
Authorization to Treat: I authorize the physicians/providers of Redbud Pediatrics, LLC to render any necessary treatment to my child. Redbud Pediatrics, LLC is providing care with the understanding that the person bringing the child to the office has been authorized by parent/guardian to make necessary medical decisions on behalf of the child. This authorizes Protected Health Information (PHI) to be shared with the person accompanying the child. This will remain in effect from this date forward unless written revocation of such.
Insurance Plan: I agree to be responsible for all copays, deductibles and non-covered services as determined by my insurance plan. I understand that copays are due at the time of check-in, regardless of the care provider who accompanies the child for the appointment. If I do not have the copay or have not come prepared to pay past due balances, I understand that my child’s appointment may be rescheduled for a later time so that I can meet my financial obligation. (Except in the case of a medical emergency). If my child’s insurance plan requires a PCP (Primary Care Physician), I will make sure that my child’s physician at Redbud Pediatrics, LLC is designated on my child’s insurance.
Balances on Account: I understand that balances are due when I receive a statement from Redbud Pediatrics, LLC, or at my family’s next appointment, whichever is sooner. I understand that my health insurance contract is between my insurance company and myself. If my insurance does not pay for services rendered by the practice within 60 days, Redbud Pediatrics, LLC may require me to pay the practice directly. The practice agrees to return payment that I have made on my account in the event that my insurance eventually pays the claim in question. If I am not responding, not able, or unwilling to cooperate or make a reasonable payment plan, the practice may ask for the assistance of an outside collection agency. If my family’s account is turned over to a collection agency, my children will be dismissed from the practice.
Credit Card on File Policy: All patients are required to have a credit card/ debit/ HSA/ flex spending card number on file with our office. The card number will be securely encrypted off site with a third party secure data center. Holding your card on file allows a method for quick and convenient payment, including copayments when a non-parental care provider brings your child to an appointment. When a balance is due you will receive a statement via postmarked mail or e- mail. If this balance is not paid within 30 days your card will be charged. For larger balances please contact Redbud Pediatrics, LLC within 30 days of receiving your statement so that we can discuss payment options with you.
Insurance/ Payment Verification: Please bring the patient’s current insurance information & credit card/ debit/ HSA/ flex spending card with you to every visit. If your insurance changes, please notify us before the appointment so we can make the appropriate changes to help you receive your insurance benefits. We attempt to verify your insurance two (2) business days prior to, and again on the morning of, your scheduled appointment. If we are unable to confirm active insurance coverage by the scheduled appointment time, you will have two options: 1.) Pay for the visit out of pocket. 2.) Reschedule for another day when you have had an opportunity to contact your insurance. For same day appointments, we will check eligibility when the appointment is made.
Late Arrivals & Missed Appointments: We ask you to arrive on time to your appointment. If you are more than 10 minutes late you may need to be rescheduled. We call to confirm appointments 2 business days in advance and request a 24-hour cancellation notice. Please call our office as soon as possible if you are not able to keep an appointment. We understand that there are family emergencies and difficulties which arise, and we therefore do not charge for missed appointments. However, if a family has a pattern of repeated missed appointments or last minute cancellations, they may be asked to leave the practice.