Financial Responsibility and Insurance

Due to federal regulations regarding patient rights we have been mandated to implement the following policies as they apply to our office:

All payments are expected at the time of service

Payment is required at the time services are rendered, unless other arrangements are made in advance. This includes applicable co-insurances, deductibles and co-payments for participating companies. Co-payments must be paid at the time of service regardless of who brings the child into the office. In cases (such as divorce) where the custodial parent is not the insurance holder, the person accompanying the child is responsible to pay copayments at the time of service. Our office will not bill for co-pays. Marblehead Pediatrics accepts cash, personal checks, VISA and MasterCard. There is a service charge of $10.00 for all returned checks.

Insurance

Marblehead Pediatrics accepts most major managed care (HMO, PPO), private indemnity, and Medicaid subsidized plans. It is your responsibility, however, to call your insurer to verify that we participate in your plan.

It is required that you bring your insurance card to every visit. Please do not assume that we already have your insurance on file. We do our best to verify your eligibility and coverage. However, it is your responsibility to know your plan's benefits, restrictions and referral requirements and to inform us of any changes in your plan.
Your co-payment is required at the time of visit. We do not bill secondary insurances for co-pays. Cash, checks or most credit cards are accepted.

Under the Affordable Care Act, there are no longer any co-pays for well visits. However, if care is provided for an acute illness or for chronic illnesses such as Asthma, ADHD, Acne or other conditions, then your insurance company may later inform you that you are responsible for a co-pay for that portion of the visit.

It is essential to enroll newborn infants with your insurance carrier within 30 days of the date of birth. Unless this is done, the child has no insurance coverage under your policy. If you fail to do this within 30 days following birth you will be billed for the services that we have provided.

If we do not receive payment from your insurance company within 60 days from the date of service, you will be expected to pay the balance in full. You are ultimately responsible for all charges.
If you need assistance or have questions, please contact our billing department. We are available to answer your billing questions Monday through Friday during our office hours. Please ask for billing when you call.

Outstanding Balances

Patients with an outstanding balance of 60 days past due must make arrangements with the billing office prior to scheduling well child appointments. School, camp and/or sports forms will not be provided for patients with accounts 60 days or more overdue unless arrangements for payment have been made with the billing office. Accounts over 90 days overdue will be considered seriously delinquent and maybe referred to our Collection Agency.

We do realize that there are extenuating circumstances and that people have financial difficulties and we are willing to work with you to help you resolve the problem. Please call the office and speak to the office manager to make special arrangements.