Billing Policies - Effective January 1, 2008 and forward

Please take some time to read through and understand our billing policies. We keep a signed billing agreement in each patient's chart. Any questions related to our billing policies can be addressed to the Office Manager, Victoria Raley, or Dr. Raley directly.


CO PAYS
All patients with a co pay are required to pay their co pay at the time of visit, prior to services rendered.

BALANCES
All patients with a balance are required to pay the balance plus their co pay or percentage if necessary, prior to services rendered. Patients may be dismissed from the practice for non payment of services.

DEDUCTIBLE PLANS
All patients on an insurance plan with a deductible are required to pay 90% of their visit at the time of service until the deductible has been met. Any adjustment received from your insurance company will be reflected in the additional 10% that will be owed after receiving the Explanation of Benefits from your insurance company.

*Copays, Deductibles, and Balances are due at time of visit, regardless of who brings the child to the appointment. Please make the appropriate arrangements for payment prior to your child's appointment. We accept Visa, Mastercard, and Discover if you would like to call ahead and pay the amount owed, or sent a check or cash with the person bringing your child to the appointment. Also, we will not post date checks, please make the appropriate arrangements for payment prior to your child's appointment.

80/20 Plans
All patients on an insurance plan that requires a 20% payment at the time of visit will be required to pay 20% of the visit at the time of service. Any adjustment received from your insurance company will be reflected in the additional amount that will be owed after receiving the Explanation of Benefits from your insurance company.

90/10 Plans
All patients on an insurance plan that requires a 10% payment at the time of visit will be required to pay 10% of the visit at the time of service. Any adjustment received from your insurance company will be reflected in the additional amount that will be owed after receiving the Explanation of Benefits from your insurance company.

SELF PAY PATIENTS
All patients that are self pay are required to pay the full amount of the visit at the time of service. For new patients that are self pay, we require $25 payment over the phone when making your first appointment, and will collect the difference at the time of visit.

SEPARATED/DIVORCED FAMILIES
For any family where parents are separated or divorced, the parent authorizing treatment and bringing the child to be seen is responsible to us for payment which is due when services are rendered. In the case that only a copay is due at the time of service, any charges deemed by insurance as patient responsibility are due to Avalon Park Pediatrics by the parent who authorized treatment.

If the divorce decree requires both parents to split the charges incurred, it is the authorizing parent's responsibility to collect from the other parent. Avalon Park Pediatrics will not act as a mediator in collecting our payments. If the account balance is not resolved in a timely manner, the authorizing parent's information will be submitted to our collection agency. Non-compliance with our policy may result in transfer of records to a different practice.

NO INSURANCE CARD AT THE TIME OF VISIT
Any patient that does not have their new insurance card at the time of service will be required to pay 50% of the visit at the time of service and provide insurance information within 2 weeks of the visit or the charges will become personal responsibility. Once insurance information is received and benefits are verified any credit amount can be refunded upon request or kept on the account for future co pays.


VACCINES
Additional paperwork and agreements may be required for certain vaccines as deemed necessary by the practice.

NO SHOWING OF APPOINTMENTS
A $25.00 No Show fee will be added to your account for any appointment that is not canceled 48 hours in advance.

RETURNED CHECK CHARGE
A $25.00 fee will be added to your account for all returned checks in additional to the amount of the check.

Once Avalon Park Pediatrics receives one returned check for insufficient funds, your account will be put on a cash and credit card only status. At that time all balances including mailed statements must be settled with cash, money order or credit card only.

AFTER HOUR CHARGE
A $25.00 After Hours Charge will be added to all accounts when Dr. Raley is seen during non â€"operating hours. You will be required to pay the charge if it is not covered by your insurance company.

There is a $15.00 After Hours Charge for emails sent to Dr. Raley outside of normal business hours.

There can a $15.00 After Hours Charge for portal messages sent to Dr. Raley through the website outside of normal business hours.

AFTER HOUR NURSE TRIAGE CHARGE
A $15.00 Triage Charge will be added to all accounts for patient calls that go to the Nurse Triage after 10pm.

AFTER HOUR REFILL CHARGE
A $25.00 After Hours Prescription Refill Request charge will be added to all accounts for any prescriptions approved and called in by Dr. Raley during non-operating hours.


*We accept Visa, Mastercard, and Discover. You can make payments over the phone during office hours.
*We do not accept post dated or temporary checks.