Welcome to South East Bay Pediatric Medical Group. We strive to provide you 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 Groups 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 on line 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. Appointments may be rescheduled if there are unpaid, outstanding balances prior to the visit. If you are experiencing financial difficulty, please let us know.
- 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. Your remittance is due within 10 business days of your receipt of your bill.
- Patients with an outstanding balance overdue by more than 60 days must make arrangements for payment prior to scheduling appointments.
- 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 sent to 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 have no 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. Payments can also be made online at sebpmg.com by clicking on “Pay Your Bill” or “Patient Portal” at the top of the page.
- 14. 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.
- 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 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/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 was seen for a Well Care Visit but had an ear infection at the time.)
Forms and Fees Policy — Usually takes 2-3 Business Days
- Failure to review and complete forms (exception: medication forms) at the time of your child’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 HIPAA 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.
- Questions that require a call back from your physician will incur a charge if the phone call lasts more than 5 minutes. We will submit a bill to your insurance company first. Please note that your insurance company may not cover phone visits. If these charges are not a covered benefit of your insurance plan you will be responsible to pay them in full.
- A $30 fee, plus any bank fees incurred, will be charged for any checks returned for insufficient funds.
- As noted above, there is a $50 charge for missed appointments.
- Release of medical records to a new physician or parent is subject to a $35 charge plus $25 if additional volumes need to be processed.
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. In this situation, the responsible person will be asked to seek medical care for their child/children elsewhere.
- Patients who are terminated due to outstanding balances may be reinstated upon full payment of the outstanding balance. Terminated patients who are subsequently reinstated are required to participate in the Easy Pay Program. Details about the program are available on our website.
- As noted above, release of medical records to a new physician or parent is subject to a $35 charge plus $25 for additional volumes per child.
- Please allow 10-14 days for transfer.
- For medication refills, we require a notice of at least two (2) business days. Prescription refill requests are accepted Monday to Friday. Please plan accordingly.
- Medication refills for controlled substances (e.g., ADHD medications) require a separate notice and handling. Please refer to the ADHD Medication Policy for details.
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. Billing for these visits as a regular doctor visit is both the national and local standard that we follow.
Exception to this policy is prenatal consults for expectant families. Prenatal consults for expectant families are scheduled as a courtesy and not charged an office visit.
Patients 18 Years and Above
When a patient turns 18 years of age, privacy laws come into effect. Even though an adult patient is still being insured under his/her parents’ insurance, we are not permitted to discuss any aspect of the patient’s care without expressed written consent from the patient detailing what portions of his/her case we may discuss. This includes release of any information involving issues that were addressed even before the 18th birthday.