Policies

Amount Owed After Insurance

When insurance information is received after the timely filing requirements of your insurance company, the charges for those services are your responsibility. You are responsible for payment of services unpaid by your insurance company and for timely payment of your account.

PHA reserves the right to reschedule or deny future appointments for delinquent accounts.

Co-payments are expected to be paid at the time service is rendered.

If payment is not received at the time of service, there will be an additional $10.00 fee.

All returned checks will be subject to a service charge of $15.00.

Please be aware that we report all evening, weekend and federal holiday visits to insurance companies.  This code may or may not be covered by your insurance.

The parent bringing the child in for care is responsible for payment of co-payments.

Both parents are responsible for payment on unpaid balances, regardless of divorce decree. If payment issues exist, they must be resolved between the parents.

Notice of Privacy Practices

Effective Date of this Notice: April 14, 2003, revised effective September 23, 2013

Privacy Contact Office: (203) 452-6240, ext. 3237

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We at Pediatric Healthcare Associates understand that our medical/health information is personal and private. In order to provide you with quality care and to ensure compliance with certain legal requirements, we create a record of the care and services you receive in our office(s).

To read the entire HIPAA / Patient Privacy Policy, click here.

Insurance card(s) must be presented at the time of service.

A copy of your insurance card(s) will be made for your file. It is your responsibility to provide updated insurance information at the time of service.

If the insurance card(s) is not presented at the time of service, the charges are your responsibility until a copy of the insurance card(s) is received.

In order for services to be billed to your insurance company, a copy of the insurance card(s) must be received within 10 days from the date of service.

A $50.00 no show fee may be assessed for all well visits, consultations and complex appointments if not previously cancelled.

If your plan requires referrals for specialty care recommended by your primary care physician, it is your responsibility to obtain information regarding these requirements and contact the referral specialist at this office to request a referral to be processed prior to the specialty appointment.

In an effort to ensure that our families have ready access to the information they need for their children’s activities and to reduce delays and disruptions to patient care due to paperwork requests, we have revised our forms policy.

To read entire PHA School, Sport & Camp Forms Policy, click here.

Payment is expected at the time of service unless other financial arrangements have been made prior to your visit. Please ask about the Vaccine for Children program.

The effectiveness of vaccines to prevent serious illness and to save lives has been proven beyond any doubt. For this reason, all children and young adults should receive the vaccines recommended by the American Academy of Pediatrics (AAP).