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NO SHOW / CANCELLATION POLICY
EFFECTIVE AS OF 1/1/06 UPDATED 08/01/08

Dear parent,

Your child health is very important to us. We would like to provide you with outstanding service. This however requires your cooperation. Keeping your appointments with the physician is essential for your child’s health. It is also vital for the smooth operation of the office.

Unfortunately we have been experiencing a 25% no show rate at our clinic! This means that 1/4th of the appointments that are made are not kept, and the doctor is not notified! This can lead to poor compliance to treatment and can hurt your child. This also leads to disruptions of the schedule. Other patients that really need an appointment that day sometimes cannot be seen, because it looks like we have a full schedule, but then some do not show…

This policy intends to correct this problem, so we can provide you with the high quality service you deserve

“The 1, 2, 3, you are out policy”

1. There will be phone call attempts to reschedule each missed appointment.
2. All missed appointments will be documented in the patient’s record and numbered with 1, 2, 3 for the first, second and third “no show”.
3. Corresponding written notices (1, 2 and 3) will be sent to your home address to have a written reminder also. If we were unable to contact you by phone these will be sent “Return Receipt, Certified” and you will be asked to respond immediately.
4. There will be a $25 “handling fee” with the first no show, and a $50 “handling fee” with the second no show.
5. These charges will be due at the time the appointment is being rescheduled. It has to be paid before your child can be seen again.
6. The third letter is the so called: “Discharge Letter”. This will be mailed “Return Receipt, Certified. At the receipt of this letter you have 30 days to find another doctor. We will see you for emergencies only during those 30 days.

Please, remember that all you have to do, if you cannot keep an appointment is to CALL and CANCEL!

If you cancel 4 hours in advance you can avoid having this policy effect you and your child. Thank you for your understanding and support in creating the best practice in the area.

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Kid's-Klinic™ Financial Policy
Effective as of 1/6/2006 UPDATED 08/01/08

Please take a few moments to review our Financial Policy.
At our clinic we are trying to do everything to hold down the cost of medical care. You can help a great deal by eliminating the need for us to bill you. (Billing cost money: personnel, equipment, postage, etc.) For this reason you will get a 5% discount if you pay your portion of the charges that left after collecting from insurance in full while you are at the clinic. This applies for the balance paid in full within the first 30 days after we have received payment from the insurance company. The following is a summary of our financial policy.

1. Payment is expected at the time services are rendered unless other arrangements have been made in advance. This includes co-payments, coinsurance payments and deductibles. Please do not ask us to waive co-payments; it is considered a breach of the insurance contract and it can lead to denial of payment by the insurance company.
2. We accept Cash, Money Orders and Credit cards. WE NO LONGER ACCEPT CHECKS- EFFECTIVE 08/01/08.
3. If your child is brought to the clinic by a relative or a friend, payment is still expected at the time of service.
4. In case of divorce or other changes in guardianship, please bring legal papers and inform our office about the responsible party for the payments.
5. Please inform our office of all billing address changes and changes of phone numbers at the time of check in.
6. If you have insurance coverage, as a courtesy to you, Kid’s Klinic will bill your insurance company, so you will not need to file your own claims. This saves you time, energy and money. In order for us to be able to verify coverage and effectively submit charges we need you to bring your proof of insurance to EACH and every visit. This includes Medicaid or Medicaid type insurance papers as well. Specifically bring to our attention any changes (new card, new group number etc.)
7. You are responsible for the outstanding balance, if:
   - at the time of your visit you are not covered by Insurance or Medicaid;
   - your coverage lapsed or had not been renewed.
   - you did not provide us with accurate information for example billing address, responsible party or insurance information etc.
   If your Medicaid lapsed, and you are about to renew it, please be aware that Medicaid will only pick up previous charges if they know about them at the time of your renewal. You need to contact our billing department and request a copy of the charges and submit it to your caseworker for processing. You will be responsible for the outstanding balance, if you do not submit them to your caseworker.
8. If you have HMO please make sure that the PROVIDER NAME on your card has been changed to Ildiko Edenhoffer MD. The insurance will deny payment if it has not been changed PRIOR TO THE VISIT and you will be responsible to pay in full for the charges occurred.
9. We recommend that you check your benefits with your Insurance Company PRIOR TO THE VISIT to avoid unpleasant surprises. Many Insurance companies limit the amount they will pay for some services, like yearly physicals and well child visits or part of services given at the time of the check up, like vision and hearing checks, or certain laboratory testing. Please check if you have “well visit reimbursement frequency or limitations”.
   In all cases, you are expected to pay for amounts your insurance company deems fair, but which do not exceed the contracted reimbursement limits.
10. We highly recommend that your child receive all “Well Child Check-ups” and all of the recommended childhood immunizations. However, if you know that your insurance company does not cover these services or part of these services, you have the option to visit our State Health Department for further care and immunizations. If Well Checks are covered, but Immunizations are not covered, your child may be eligible to receive Texas State Vaccines at our clinic. Please call it to our attention if that is the case.
11. If you have multiple coverage, make sure you let us know which insurance is the primary insurance. If you have multiple coverage that includes Medicaid, Medicaid always considered secondary. We have to bill the primary carrier first, so please bring your primary insurance information with you. Not having this information will result of the denial of the claim, which delays us receiving the payments and you might be found responsible for the charges occurred.
12. If for reasons that you failed to give us accurate information and we have not received payment from the insurance company in 45 DAYS you will be expected to pay the balance in full. You may want to resubmit the claims so you receive reimbursement. We will be glad to provide you with the necessary information for submitting claims.
13. We will bill you (and a letter will be sent to the address you provided) for your portion of the charges that is left after we have received payment from the insurance company. You have 30 DAYS to clear your balance, after 30 days it is considered overdue. (As mentioned above if at that point you pay in full at the window you will receive a 5% discount.) After the 30 days your balance is overdue and a “late fee” of $5 will be added to your balance to cover the expenses of billing you again. At that point a second letter will be sent to notify you. Patients with outstanding balances of grater then 60 DAYS overdue must make arrangements for payment prior to scheduling a visit and will be sent for collections. We realize that people have financial difficulties. Therefore we may advise you to receive your child’s immunizations through the Health Department.

• Your insurance company might deny payment for the following reasons:
  There is a preexisting illness or condition that they do not cover.
• You have not met your full calendar year deductible.
• The type of medical services requested are not covered.
• The insurance was not in effect at the time of service.
• You have other insurance that needs to be filed first.
• You have exceeded the dollar/visit amount allowed.
• You did not have a referral number for your visit.
• You have failed to change the name of the PCP on the card.
  
  If your insurance company denies your claim for any reason it is your responsibility to pay the bill in full by no later then 60 days. We will be glad to give you the information that is needed to fight the claim further, but for our clinic to operate efficiently we cannot take further financial responsibility for it.
  Following the recommendations above will help you avoid unnecessary charges and help us provide high quality care to your child. Your child’s health is priority at our clinic and we would like to provide you with the best possible care. Should you have any questions please contact our Office Manager at 972 969-4230 ext. 107.