SVPAM Financial Policy

Thank you for choosing Sewickley Valley Pediatric & Adolescent Medicine (SVPAM) as your child’s health care provider. SVPAM is committed to providing quality medical care in a cost effective manner. To assist us in achieving that result, it is important that you have a clear understanding of our Financial Policies. The purpose is to provide you with a written summary of those policies. SVPAM asks that you read and become familiar with our policies. You will be asked to sign a Financial Policy every year indicating your understanding and acceptance of these policies. *Please note that SVPAM accepts and participates with hundreds of insurance plans/carriers including PA Medicaid and we do not discriminate in care/services based on insurance type or ability to pay or not pay. If you have any questions with regard to these policies, please contact the SVPAM Business Office at 724-935-2610.

OUR FINANCIAL POLICIES

You understand that all patients are required to complete SVPAM’s patient registration process at each visit. This information assists SVPAM in billing for the services it provides and assures that we have current contact information for clinical purposes.

You understand that your insurance coverage is a contract between your employer and the insurance carrier (group coverage) or you and the insurance carrier (individual coverage). As a courtesy to its patients, SVPAM will submit claims to your insurance carrier using appropriate billing and coding guidelines. Insurance plans vary considerably. SVPAM can not predict nor guarantee what part of its services, if any, will or will not be covered by your particular plan. You are responsible for paying all co-insurance amounts, co-payments, deductibles and charges for non-covered services. Payment is expected in full when services are rendered, unless other arrangements have been made with SVPAM’s business office.

Proof of Insurance: All patients must complete SVPAM’s registration process. In addition, all patients must provide SVPAM with a copy of your/your child’s CURRENT insurance card. If you do not have this available at the appointment, you will be responsible for payment of all services rendered. UNDER ALL CIRCUMSTANCES, IF YOU PROVIDE INSURANCE INFORMATION TO SVPAM AFTER THE DATE FOR TIMELY FILING OF AN INSURANCE CLAIM, YOU WILL BE SOLELY RESPONSIBLE FOR PAYMENT OF ALL CHARGES FOR SERVICES RENDERED.

SVPAM requests full payment at the time of service for those without insurance unless payment plans have been arranged in advance with SVPAM’s Business Office at 724-935-2610.

Proof of Identity: You are required to provide government issued photo identification at every visit so that your identity can be verified as per SVPAM policy with regard to the safety of our pediatric/adolescent patients.

Special Need: There are times when making a payment can be a financial hardship. It may be necessary to set up a payment plan if you can not comply with our financial policies. If you are in need of special payment arrangements, please contact us at 724-935-2610 prior to your visit. We will work with you during this time of need. Co-payments, however, are exempt from such payment plans since your insurance carrier requires you to pay any co-payment at the time services are rendered.

No Show Appointments: SVPAM reserves the right to charge a $25.00 fee for all NO SHOWs and last minute cancellation. A last minute cancellation is an appointment that is cancelled less than 24 hours prior to the scheduled appointment time. Additionally, SVPAM may discharge a patient from our practice after 4 or more NO-SHOWS or last minute cancellation occurrences in one-12 month period.

Well-child Appointments: If an SVPAM provider performs a well-child physical exam, SVPAM must bill it as such, even if medical problems are dealt with at the same visit. Many insurance plans will only pay for one well-child exam per year after the age of 2 years. It is your responsibility to know the rules of your particular health plan. SVPAM can not and will not change how it bills or codes a visit in an attempt to obtain payment from your insurance plan.

Co-payments: The contract between you and your insurance company mandates payment of all co-payments at the time services are rendered. In the event this requirement is violated, your account will be assessed a $20 fee per offense.

Forms of payment: SVPAM accepts cash, personal checks, money orders, VISA, Mastercard, Discover and American Express. There will be a $30.00 insufficient funds fee added to your account in the event of a returned check.

Collection Procedures: If an open balance remains on your account for over 90 days, you will receive a letter stating that you have 10 days to pay your account in full. If you cannot meet this obligation, you must contact the SVPAM Business Office at 724-935-2610 to discuss your eligibility for a payment plan. Please be aware that if your balance remains unpaid, SVPAM will refer your account to an outside collection agency. In addition, you may be subject to discharge from the practice.

Form Fees: Any forms presented at the time of a well-child visit, with the exception of Family Medical Leave Act forms (FMLA), are completed at no charge. You will be charged a $10 fee per form for forms presented at other times throughout the year. One exception is that a Work Permit carries a $5.00 fee. Some forms do not carry a fee for completion. These include, but are not limited to: WIC forms, Medication forms, Government Agency Disability Forms, Health Assessment forms requested by a specialist and/or requests to participate in Special Olympics, Make-A-Wish, or similar activities.

Medical Records: There is not charge to copy and send your Medical Records to another physician for continuation of care. SVPAM will charge a fee to copy and send your Medical Records to a third party for other purposes, including, but not limited to, disability claims and legal actions. SVPAM will assess a fee for hand carried Medical Records.

Outside Services: When labs, x-rays, or other tests are ordered by SVPAM providers, you are responsible to know where your insurance company authorizes these services to be performed. SVPAM will not be responsible for any charges resulting from your use of an unauthorized facility.

The adult who accompanies a minor to a visit and the minor’s parents and/or legal guardians are responsible for full payment of all amounts due SVPAM at the time of services. SVPAM will not be involved in negotiating or resolving payment issues between parents involved in disputes.