LaTouche Pediatrics, LLC Financial Policy

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LaTouche Pediatrics, LLC Financial Policy

LATOUCHE PEDIATRICS, LLC
FINANCIAL POLICY

Thank you for choosing us as your health care provider! We are committed to providing excellent healthcare. The following is a statement of our Financial Policy. Please read and sign this prior to any treatment in our office.

All patients (parents or guardians) must complete our Patient Information and Financial Policy before seeing the Provider.

PAYMENT IS DUE AT THE TIME OF SERVICE.

WE ACCEPT CASH, CHECKS, VISA/MASTERCARD, DISCOVER.

WE OFFER A PAYMENT PLAN WITH PRIOR BUSINESS OFFICE
APPROVAL

10.5% APR ASSESSES ON ALL ACCOUNTS OVER 60 DAYS.

THERE WILL BE A $25.00 SERVICE CHARGE ON ALL NSF CHECKS (accounts with non-sufficient funds).

Regarding Insurance:
As a courtesy, we bill most insurance plans on your behalf. You authorize us to release information needed to process your claims, and allow insurance benefits to be paid directly to our providers. It is our goal to provide fast and efficient billing. In order to achieve this goal, it is imperative that we are provided with complete, accurate, and timely insurance information. It is your responsibility to inform us of any changes in your insurance coverage. Many plans have a limited amount of time in which they will allow for billing of claims. Knowledge of your deductible, co-pays, and plan benefits is your responsibility. All deductibles and co-pays are due and payable at the time of treatment. Please have your insurance card at every visit in the event it may be required.
Your insurance policy is a contract between you and your insurance company, and we are not a party to that contract. Please be aware that you are responsible for any charges not covered by your insurance for any reason.

We are Participating Physicians with Blue Cross of Alaska, and Preferred Providers for Federal Blue Cross, Aetna, Great West, and Cigna. Our providers are credentialed to provide services to Medicaid/Denali Kid Care recipients. As Medicaid/Denali Kid Care recipients, you are expected to provide proof of eligibility at every visit and to be aware of your child�s eligibility dates to avoid any lapse in coverage. In the event coverage has lapsed, you may be asked to reschedule any non-acute visits until eligibility is obtained. You are responsible for payment of any services provided to your child if they are not eligible at the time of service.

Usual and Customary Rates
Our Practice is committed to providing the best treatment for our patients, and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company�s arbitrary determination of usual and customary rates.

Minor Patients
The adult accompanying a minor (parent, guardian or authorized representative) is responsible for payment. Anyone other than a parent or legal guardian should have written authorization on file in order to accompany the minor child for treatment.

Thank you for understanding our Financial Policy. Please let us know if you have any question or concern.

Last Updated September 15, 2008