Financial Policy – Revised January 2022
Welcome to South East Bay Pediatric Medical Group. We strive to provide our patients with the highest quality medical care. In an effort to foster a collaborative relationship, we ask that you review our updated financial policy so that you understand your responsibilities in this relationship. Our goal is to provide and maintain an excellent physician-patient relationship. Letting you know our office policy in advance allows for an effective flow of communication and enables us to achieve our goal. If you have any questions, please do not hesitate to ask a member of our staff. South East Bay Pediatric Medical Group (SEBPMG) reserves the right to make changes in this policy as needs arise. For the most updated policy, please refer to this website.
- On each arrival, please check in at the front desk and present your current insurance card and photo ID. If you are new to the practice, or if your insurance or demographic data has changed, you will be asked to fill out our registration paperwork. These forms for registration are also available online and can be downloaded and completed prior to your visit. This is your verification of the correct insurance and consent to bill them on your child’s behalf. If the insurance company or information that you designate is incorrect, you will be responsible for payment of the visit.
- According to your insurance plan,you are responsible for any and all co-payments, deductibles, and coinsurances. Co-pays are due at the time of the visit by the person who brings the child into the office.
- While filing of insurance claims is a courtesy that we extend to our patients, all charges not covered by your insurance company are your responsibility. Parents are ultimately responsible for any charges or portion thereof for which payment is denied by insurance for any reason, except where prohibited by law or prior contractual agreement.
- Patient balances are billed immediately upon receipt from your insurance plan’s explanation of benefits. We request that you pay your outstanding balance within 10 business days of your receipt of your bill.
- If previous arrangements have not been made with our billing office, any account balance overdue by more that 60 days will be forwarded to a collection agency.
- If you have personal financial problems, a monthly payment plan may be arranged. Please call our billing department and speak to one of our billing personnel. If an account is referred for collection, extra charges will be assessed
- If our physicians do not participate in your insurance plan, payment in full is expected at the time of your office visit.
- If you do not have health insurance, payment for an office visit is due at the time of the visit.
- Health insurance is a contract between you, your employer, and your insurance company. It is your responsibility to be familiar with the specifics of your insurance policy, including, but not limited to: vaccine and doctor visit coverage, referral/authorization requirements for specialty care, radiology, lab tests, and emergency and/or hospital care.
- Not all services provided by our office are covered by every plan. Medical care and treatment for your child is dictated solely by medical necessity, and is not based on medical insurance coverage. Any service not covered by your plan will be your responsibility.
- Our billing department is outsourced to a separate office location. The billing office phone number may be found on our website (sebpmg.com). Please do not call our office for any billing questions, as calling our billing company will be the best way to get your concerns addressed. However, in the event that our billing company cannot resolve your problem, please feel free to contact us.
- South East Bay Pediatric Medical Group accepts payments through personal checks, VISA, MasterCard, and Discover cards.
- For patient convenience, South East Bay Pediatric Medical Group offers a service to securely hold your credit card securely with a processing company. Called “Easy Pay,” credit cards are imprinted and later used to pay your bill. Your credit card information will be held safely, encrypted, and secured with a processing company. More information is available on our website under the “Easy Pay” banner.
- Effective January 11, 2022, South East Bay Pediatric Medical Group is an affiliate of UCSF Benioff Children’s Physicians (UBCP). Billing is done through UBCP.
- If you are late for an appointment, we will do our best to accommodate you. However, it may be necessary to reschedule your child’s appointment to a later time or, if non-urgent, to another day.
- Missed and cancelled appointments represent a cost to us, to you, and to other patients of our practice who could have been seen in the time set aside for you. We reserve the right to charge a fee for cancelled or missed appointments. For cancellations, a 24 hour notice prior to the appointment is required. Failure to cancel with notice will result in a $50.00 missed appointment charge. Multiple missed appointments may result in dismissal from the practice.
- We will not schedule further routine appointments for your child if your account is turned over to a collection agency or if you default on a payment plan.
- We strive to minimize wait time. However, emergencies and unexpected prolonged visits do occur and will take priority over a scheduled visit. We appreciate your patience and understanding.
- As a courtesy, we can either email or text to remind parents about their appointments. If we are unable to reach you, the ultimate responsibility to remember the appointment is yours. You will be responsible for a missed appointment charge if an appointment is missed.
- A Well Care Visit, also known as a Routine Physical, is a Preventative Health Maintenance Visit. This is a routinely scheduled visit recommended by the American Academy of Pediatrics. Insurances typically cover Well Care Visits and do not require a copay at the time of the visit.
- An Office Visit is a non-routine visit for a specific health problem, question, or concern. This visit is problem oriented and meant to address a specific health question. Insurances may require us to either (1) collect a copay at the time of the visit for these appointments, and/or (2) apply charges for the visit to deductibles/co-insurance per insurance requirements.
- It is the patient’s responsibility to be familiar with the specifics of your insurance policy regarding Well Care Visits and Office Visits, including, but not limited to: copays, vaccine and doctor visit coverage, referral and authorization requirements for specialty care, radiology, lab tests, and emergency and/or hospital care. Well Care Visits and Office Visits may be coded at the same appointment if both were done at the same appointment. (e.g. a patient seen for a Well Care Visit but also treated for an ear infection)
- A Telehealth or Video Visit for a specific health problem, question, or concern is considered an Office Visit. This visit is problem oriented and meant to address a specific health question. As for Office Visits, insurances may require us to either (1) collect a copay at a later date for this appointment and/or (2) apply charges for the visit to deductibles/co-insurance per insurance requirements.
- Questions that require a call back from your physician to address a specific health problem, question, or concern are considered Telephone Consultations and may incur a charge.This may or may not be covered by your insurance plan and/or applied to your deductible. We will submit a bill to your insurance company first. You are responsible for these charges if they are not a covered benefit of your insurance plan or if insurance applies the charge towards your deductible. A Telephone Consultation for a specific health problem, question, or concern may be billed as an Office Visit during the COVID pandemic.
- Email Consultations to address a specific medical question, problem, or concern may incur a charge. This may or may not be covered by your insurance plan and/or applied to your deductible. We will submit a bill to your insurance company first. You are responsible for these charges if they are not a covered benefit of your insurance plan or if insurance applies the charge towards your deductible. Email consultations may be answered by email or by phone by our staff and/or physicians. Email consultations may transition to Telephone Consultations depending on the nature of the discussion.
Forms and Fees Policy
- Failure to review and complete forms (with the exception of medication forms) at the time of yourchild’s appointment will result in a $10 fee. Please bring your form to your physician visit or request a generic form from our office that might fulfill the requirements of your organization. Please allow 3-5 business days for forms dropped off at our office to be completed. Urgent requests (turnaround in 48 business hours or less) will be assessed an additional charge of $15 (total charge $25). Payment, which can be made in cash, check or credit card, is required at the time of service. Due to confidentiality laws, we are unable to fax or mail forms to any third party; we can only mail the forms to your home address or keep them in our office to be picked up.
- There is a $35 charge for after-hours calls transferred to an advice nurse or a physician. This charge represents cost we incur in providing this important service. If these charges are not a covered benefit of your insurance plan, you will be responsible for the fee.
- There is a $10 charge to replace a lost immunization card.
- A $30 fee, plus any bank fees incurred, will be charged for any checks returned for insufficient funds.
Termination and Collection
- As stated above, all fees are due at the time of service. Any charges left unpaid sixty (60) days after the date of service are considered past due. In this case, we will make every effort to contact the person responsible for the delinquent balance, and arrange an equitable payment schedule. However, if an effort is not made to pay the balance due, it may be sent to a collection agency. For situations in which past due balances are not paid, SEBPMG reserves the right to withdraw from the patient’s care.
- Patients who are terminated from SEBPMG due to outstanding balances may be accepted back into the practice, at our discretion, upon full payment of the outstanding balance. Terminated patients who are subsequently accepted back will be required to participate in the Easy Pay Program as a condition of their reinstatement. Details about the program are available on our website
- In accordance with state and federal law, and with some limited exceptions, SEBPMG will allow parents or legal guardians to review a minor patient’s medical records within 5 working days upon receipt of a written request. For copies of records, SEBPMG will provide copies within 15 working days upon receipt of a written request. SEBMPG charges reasonable, cost-based fees for copying medical records, in the amount of $0.25/page. If you request that records be provided on electronic media (such as a USB drive or CD/ROM), there will also be a reasonable charge for the cost of the media.
- Requests to forward records to other providers will be subject to the same costs of $0.25/page, as outlined above. Please allow 10-14 days for transfer of records.
- Please note that patients over the age of 18 may request to review or receive a copy of their medical records, as noted above. Additionally, minors who are legally able to consent to certain treatment, such as treatment or counseling related to birth control/family planning, pregnancy, or sexually-transmitted diseases, may request records related only to that treatment. In both situations, parents or guardians will not be provided any information or records unless the patient signs an Authorization for the Release of Protected Health Information.
- For records needed to support a claim or appeal regarding eligibility for certain public benefit programs, with some exceptions, patients and parents/guardians are entitled to one copy of relevant medical records at no cost. Please contact us if you require records to provide to a public benefit program.
At times, the doctor and/or parent(s)/guardian(s) may decide it is in the best interest of the patient to have an appointment without the patient present. These appointments without the patient present are treated as regular appointments, and billed accordingly. Parents are thereby responsible for the contracted co-pay and any charges not covered by their insurance arising from these appointments. The most common examples are parental concerns about behavioral problems, ADHD, depression, anxiety, or substance abuse.
An exception to this policy is prenatal consults for expectant families, which are provided as a courtesy and not charged as an office visit.
Patients 18 Years and Above
Please note that, along with changes in patient consent and privacy (as outlined in the Office Policy), patients over the age of 18 will be held financially responsible for their patient accounts, even if they are still covered under their parents’ health insurance. Adult patients will be asked to personally review and sign SEBPMG policies following their 18th birthday.