Waterville Pediatrics Office Policy Our goal is to provide and maintain a good physician-patient relationship. Letting you know in advance of our office policy allows for a good flow of communication and enables us to achieve our goal. Please read each section carefully and initial. If you have any questions, do not hesitate to ask a member of our staff.
- We value the time we have set aside to see and treat your child. If you are not able to keep an appointment, we would appreciate 24-hour notice. Multiple missed appointments can be grounds for discharge.
- If you are late for your appointment (>10 minutes), we will do our best to accommodate you. However, on certain days it may be necessary to reschedule your appointment.
- We strive to minimize any wait time; however, emergencies do occur and will take priority over a scheduled visit. We appreciate your understanding.
- Before making an annual physical appointment, check with your insurance company as to whether the visit will be covered as a healthy (well-child) visit.
- It is your responsibility to keep us updated with your correct insurance information. If the insurance company you designate is incorrect, you will be responsible for payment of the visit and to submit the charges to the correct plan for reimbursement.
- If we are your primary care physician, make sure our name or phone number appears on your card. If your insurance company has not yet been informed that we are your primary care physician, you may be financially responsible for your current visit.
- It is your responsibility to understand your benefit plan with regard to, for instance, covered services and participating laboratories. For example:
- Not all plans cover annual healthy (well) physicals, sports physicals, or hearing and vision screenings. If these are not covered, you will be responsible for payment.
- For children younger than 2 years, there is a limit as to the number of allowable well visits per year. If the number of visits is exceeded, your insurance company will not pay; you will be responsible for payment.
- It is your responsibility to know if a written referral or authorization is required to see specialists, whether preauthorization is required prior to a procedure, and what services are covered.
- Advance notice is needed for all non-emergent referrals, typically 3 to 5 business days.
- It is your responsibility to know if a selected specialist participates in your plan.
- Remember, we must approve referrals before they are issued.
- According to your insurance plan, you are responsible for any and all co-payments, deductibles, and coinsurances.
- Co-payments are due at the time of service.
- Self-pay patients are expected to pay for services in FULL at the time of the visit.
- If we do not participate in your insurance plan, payment in full is expected from you at the time of your visit. We will supply you with an invoice that you can submit to your insurance for reimbursement.
- Patient balances are billed immediately on receipt of your insurance plan’s explanation of benefits. Your remittance is due within 10 business days of your receipt of your bill.
- Any balance outstanding longer than 90 days will be forwarded to a collection agency.
- For scheduled appointments, prior balances must be paid prior to the visit.
- For those patients with health saving accounts, payment is due at the time of service and a receipt will be provided to you to submit to your account for reimbursement.
- We accept cash, checks, Visa, MasterCard, Discover, and debit cards.
- A $25 fee will be charged for any checks returned for insufficient funds.
Transfer of Records
- If you transfer to another physician, we will provide a copy of your immunization record and your last visit on disk to your physician, free of charge, as a courtesy to you. We need 48 hours’ notice.
- A copy of your complete record is available for a $10 for the first page and $0.35 per each additional page. This request will be completed within 30 days.
- We provide records of your child for visits (including consultations from specialists) rendered here at Waterville Pediatrics only. For any previous records, you must request them directly from your previous doctor(s).
- For monthly medication refills, we require 48 hours’ notice, during regular business hours. Controlled substances require five business days to accomplish. Please plan accordingly.
The Financial Agreement
We must emphasize that as pediatric providers, our relationship is with you, not your insurance company. While the filing of insurance claims is a courtesy that we extend to our patients, all charges are strictly your responsibility from the date services are rendered. Therefore, it is necessary for you to know what benefits your insurance plan provides for you.
Hours of Operation
Monday - Friday
8:00 am - 6:00 pm
Walk in hours: 8:00 am - 8:30 am
Monday - Friday
Saturday, Sunday & most holidays
same day appointments available.
Our Madison Office is now closed.