We love providing you the best pediatric care possible. In order for us to continue caring for your children, we must charge for these services and expect prompt payment. Below is a list of our billing policy that will help us continue to deliver the highest quality medical care that you deserve.

• Patients are responsible for full payment of charges incurred during each appointment. Our staff will collect payments based on the patient’s insurance coverage and benefits. Patients with delinquent balances are asked to pay before seeing the provider or clinical support staff.
• We must have updated information on your insurance and identify information at every visit. It is your responsibility to let us know of any changes in insurance data, addresses, telephone numbers, etc. When a patient checks in for an appointment, the patient, parent/guardian receives an assignment-of-benefits statement to sign. This statement reads:

I hereby assign the benefits from any insurance or third party to Gentle Pediatrics PLLC for medical services provided to me. I understand that Gentle Pediatrics PLLC has the right to decline or accept assignment of such benefits. If these benefits are not assigned to Gentle Pediatrics PLLC, I agree to forward to the practice, upon receipt, any insurance or third party payments I receive for services rendered to me.

1. Responsible party with delinquent accounts must pay in full for future services. If a party does not make payment, management can determine that the practice will refuse to provide nonurgent services to the patient.
2. For a patient, parent/guardian making the first appointment after establishing a delinquent balance, staff requests the patient pay the full balance at or before the time of the appointment. The patient is informed that if the balance is not paid or if the patient does not arrive for the appointment, staff will require full payment before scheduling future appointments. The patient is directed to contact the business office to settle the account.
3. Staff notifies management of a patient’s delinquent status before his or her next appointment. Management can opt to deny the patient routine services.
4. The responsible party has a delinquent account if he or she maintains a balance that is more than 120 days past due and the party has not made any payments or contacted the practice about financial hardship.
5. If a patient or parent/guardian maintains a delinquent balance for more than 150 days without making any payments or contacting the practice about assistance because of financial hardship, staff confers with the provider for approval to notify the patient that he or she has 30 days to find another provider. At that time, the practice will dismiss the patient according to the termination policy