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Payment Policies

Insurance Information

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.

Account Balances

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.

Self Pay

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.

Divorce Situations

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.


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.

No Shows

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