Financial Policy of Over the Moon Pediatrics

Insurance

Over the Moon Pediatrics participates with most insurance plans. As a courtesy to our patients, we will gladly file the forms necessary so that you receive the full benefits of your medical coverage. Each insurance policy is different and it is therefore impossible for us to know what your particular benefits may be. Therefore, it’s important to contact your insurance company if you have any questions regarding your benefits and for you to know what your payment obligations will be at the time of service. If your insurance company denies coverage, or we otherwise do not receive payment 60 days from filing your claim, the amount will then become due and payable by you.

Copayments and Deductibles

Depending on your insurance policy, a copayment and/or deductible may be required at the time of service. These payments are expected to be made at the time of service. Payments may be made in cash, by check or by credit card. We also accept Health Savings Account (HSA) cards for payment.

Please note that the copayment is a contractual requirement from the insurance company and cannot be written off by the clinic. If you participate in a High Deductible Health Plan (HDHP) and have not yet paid your deductible in full, it is likely that any non-preventive services will require payment at the time those services are rendered. Coinsurance may even apply even after meeting your deductible. We are happy to discuss arrangements for payment by installment if you need to do so.

Please ensure that if you are unable to bring your child in yourself, whoever brings the child in is prepared to make all payments, otherwise the credit care on file will be charged.

Patients Without Insurance Coverage / Non-Covered Expenses

We are happy to work with families that prefer to pay directly for services, do not have insurance, or would like services that are not covered by their insurance. For such patients, a time of service discount will be applied to the bill if settled in full on the day of service. This discount does not apply after the day of the visit.

Financial Arrangements

Because we realize every person’s financial situation is different, we provide a variety of payment options. For your convenience, we accept all major credit cards, cash, and checks. Returned checks will be subject to a $35 returned check fee. If you would like to make arrangements to pay the amount by installments, please notify the office in advance.

Appointment Cancellations and No-Show/Missed Appointment Fees [1]

Missing an appointment without giving prior notice to the practice deprives other patients of the chance to take a slot that opens up. We reserve the right to charge $25 for appointments (well exams, sick exams, and shot only appointments) canceled without advance notice of at least 1 business day, appointments that are scheduled for the same day and then canceled, and no-shows or missed appointments. Patients are considered to have missed their appointments if they arrive more than 20 minutes late. We understand that life happens and therefore, all patients are allowed one “free” missed appointment charge. Subsequent no-show or missed appointment charges will be charged to the patient. Repeated no-shows or same-day cancellations will result in the family being dismissed from the practice.

Divorced/Separated Parents and Custodial Arrangements

Over the Moon Pediatrics does not get involved in disputes between divorced, separated or custodial parenting arrangements regarding financial responsibility for their child's medical expenses. By signing as guarantor below, you agree to be financially responsible for the care we provide to your child, regardless of whether a divorce decree, custodial or other arrangement places that obligation on your former spouse or the child’s other parent. We will be happy to provide receipts for paid medical bills for you as requested.

Other Fees

Forms         

Forms brought on the same day as the child’s well visit will be completed before you leave the office. If you have forms that require completion by a physician and you did not bring them to your child’s well visit, you can mail, fax, or email them to us with your child’s information already filled out.

For regular processing, please allow at least 1 week (5-7 business days) to complete and return your form.

Forms requiring expedited processing will be subject to a fee.

The fee for same-day processing is $30 per form.

The fee for 2-day processing is $15 per form.

Well Exams

During a well exam, many services are included and covered by your insurance. Occasionally during the course of your visit, new or urgent issues may be diagnosed and treated. Since these are not typically included in a preventive visit, we may bill them as a separate, problem-focused service on your preventive visit. In some cases, your insurance carrier may require that your copay, co-insurance, or deductible be applied.

Credit Card on File [2]

In order to make sure that we can collect your portion of the bill once your insurance company processes the claim, we request that a valid credit card be kept on file with the practice. Your card will only be charged the outstanding amount that your insurance company determines to be ‘patient responsibility’, as spelled out in your Explanation Of Benefits (EOB). Once your card is charged, a receipt will be sent to you by email.

[1] This fee does not apply to patients with Medicaid and Medicaid HMO insurance. Dismissal terms still apply.

[2] This policy does not apply to patients with Medicaid and Medicaid HMO insurance