• Effective Sept 1, 2014, we will no longer accept personal checks
• Copays- As participating providers with your insurance plan, it is required to collect your copayment on the date of service. If payment is not received at the time of visit, you must call in and make payment prior to the end of day. If we do not receive payment by the end of the day, a $10 late fee will be applied.
• Uninsured-If you have no insurance coverage, payment is due at the time services are rendered. A credit card will need to be kept on file.
• After Hour Calls- As of February 1, 2019 a $17.00 fee will be incurred for after hour calls
• No Show Fee-Failure to cancel your appointment within 24 hour notice will result in a $50.00 charge
• Nurse Visit- A $20.00 charge will be incurred for nurse visits
• Forms- A $10 charge will be incurred for all forms and letters that require more than a signature. These are often lengthy and take extra time to be completed. Please all up to 4 business days for these to be completed.
• Late Fee-If payment is not received in a timely manner, your account will be billed a $25 late fee per monthly billing cycle. After three (3) billing cycles your account will be turned over to a collection agency and you will be responsible for all service fees.
• Returned Checked- $35 will be charged for any checks that are returned NSF.
• As the guarantor, you are responsible for all remaining balances after the insurance has paid. This includes coinsurance, deductibles, and non-covered services.
• Payments on any outstanding patient balances are due at time of visit.
• If the 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 be the responsible guarantor.
• In a divorce situation, the parent who brings the dependent child to our office is responsible for payment. Insurance may be filed, but the parent in attendance will be responsible for any copayment or outstanding balances.

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.

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.

Healthcare MarketPlace continues to add additional plans. Due to the increase, it is difficult for our office to keep up with all of the new plans formed.

Until further notice, the ONLY plan that we are participating with through the Healthcare MarketPlace is BCBS HMO/Advantage.