Financial Policy

      The staff of Holliston Pediatric Group is pleased to be of service to you and your family. We are all concerned about the rising cost of healthcare and would like to do everything possible to contain these expenses. It is our sincere desire to provide your family with excellent medical care at a fair and reasonable fee. In general, office fees are based on the type of evaluation and the complexity of services provided to your child. The following is a summary of our financial policy:

• Unless prior arrangements have been made, payment is expected at the time services are rendered. All balances are due in full within 10 days of billing. For your convenience we accept Master Card, Visa, Discover and American Express.


• We are aware that unforeseen situations may arise that result in financial difficulties. Please contact our billing department (508 429-2800) in the event you warrant special payment considerations. Please do not wait until your account becomes delinquent to seek help.

• We have contractual agreements with various HMO/PPO organizations, as well as BCBS of Massachusetts. If you are insured by one of these contracted carriers, your policy states that it is your responsibility to do the following at the time of service:
• Present your child's insurance card.
• Be prepared to pay your co-payment/co-insurance as stipulated in your contract. Effective July 1, 2004 , , we will assess a $10.00 surcharge per child, per date of service for any co-payment/co- insurance not paid at the time of service.
• Inform us of any insurance/billing changes.


• Communicating your insurance information to us and payment of applicable co- payments etc. is the responsibility of the person bringing your child in for care. If someone other than a parent brings your child into our office he/she should have written authorization from you, be prepared to provide accurate insurance and billing information, and pay the appropriate co-payment/co-insurance on your behalf.

Emergency Room/ After Hours Care
     If we find it necessary to refer your child to an emergency room or to an after hours facility please let us know if your insurance carrier stipulates a specific facility for this type of care. Care at out-of-network facilities has a higher financial obligation for the subscriber.

Referrals
     If you are insured with a managed care plan (i.e. HMO/PPO), you may be responsible for obtaining a referral from your child's primary care physician prior to seeing a specialist. Referral requests should be made at least one week prior to the appointment date (in some instances, a referral may require prior authorization from your insurance carrier). Retroactive referrals cannot be assured. Failure to obtain the appropriate referral prior to your child's appointment with a specialist may leave you at risk for payment of all charges associated with the appointment.

Missed Appointments/Last Minute Cancellations
     Missed appointments/last minute cancellations are a difficulty for us and for other patients who could have been seen at the time set aside for your child. Cancellations should be made at least 24 hours in advance whenever possible. We reserve the right to charge for no shows and last minute cancellations.

Dishonored Check Policy
     All checks returned by the bank will be charged a $25.00 processing fee. If payment (credit card, cash or money order) is not reissued within 30 days of billing, Holliston Pediatric Group has the right to proceed with legal action. In the state of Massachusetts , the maximum fee for writing a bad check is $500.00.

In Conclusion
     We hope this policy will help you understand our goals and address any questions you may have about our payment policy. It is our privilege to provide medical care to your family. If at any time you encounter any problems or have any questions, please do not hesitate to contact us. All members of our medical team and office staff are pleased to be of service to you and your family.

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