Financial Policy: Understanding Your Responsibilities

Registration and Insurance Information

• Registrations are updated annually and whenever there is a change in personal information to ensure our records are current.

• Updated Insurance Information: If your insurance changes, please provide us with your new insurance details as soon as possible.

Payment, Deductibles, and Co-Payments

• Payment at Time of Service: Payments, deductibles, and/or co-payments are due at the time of service.

• Insurance Cards: A current insurance card must be presented at the time of service.

• Insurance Issues: If charges are filed incorrectly due to outdated insurance information or if your coverage has been terminated, the full balance becomes your responsibility.

• Health Savings and Reimbursement Accounts: If you have an HSA or HRA, a minimum of $65.00 is expected at the time of service until your deductible has been met.

• Accepted Payment Methods: We accept cash, check, Visa, MasterCard, and Discover.

Coordination of Benefits (COB)

• COB Updates: Your insurance company periodically updates coordination of benefits information. Insurance companies must determine if you have other insurance coverage.

• Responsibility: If you do not provide updated COB information to your insurance company, they may deny claims until the correct information is received. You will be responsible for any balance incurred due to incorrect or missing COB information.

Newborn Enrollment

• Adding Newborns: Most insurance companies allow 30 days to add your newborn to your policy.

• Timely Enrollment: It is your responsibility to ensure the required paperwork is submitted to your insurance company and/or Human Resource Department as soon as possible.

• Failure to Enroll: If you fail to add your newborn child to your insurance policy within the required time, you will be responsible for any charges not covered by your insurance.

Insurance Plan Responsibilities

• Know Your Insurance: It is your responsibility to know the details of your insurance plan, including co-pays, co-insurance, and deductibles. If you have any questions regarding coverage, please contact your insurance carrier.

• Billing Inquiries: For billing questions, contact our Billing Office at 859-282-4123, Monday through Friday, between 8:00 AM and 3:00 PM.

High Deductible/Indemnity Insurance Plans

• High Deductible Plans: If you have a high deductible or indemnity insurance plan, we will file your claim directly with the insurance company. However, $65.00 payment is required at the time of service until your deductible is met.

Additional Fees

The following fees will be added to your account for various services:

• $10.00 for failure to make the co-pay at the time of the visit.

• $25.00 for returned checks.

• $25.00 prepaid clerical fee for completing forms (e.g., Family Medical Leave, Guardianship, etc.).

• $10.00 for replacing a physical/sports physical form.

• $5.00 for replacing an immunization certificate.

• $5.00 for requested billing general ledgers.

• Walk-in Appointments and after-hours appointments incur an additional fee.

• Missed Appointments or consultations without 24-hour notice of cancellation will incur a fee.

Recommendations for Future Reference

Physical Forms and Immunization Certificates: It is strongly recommended that you make an additional copy of your child’s physical/sports physical forms and immunization certificates for your own reference.

Delinquent Accounts and Collection Services

• Collection Service: If accounts become delinquent, we will retain a collection service.

• Well-Child Care: Future well-child care or checkup appointments will not be scheduled until all outstanding balances are paid in full.

• Termination of Care: If accounts remain delinquent, we may issue a termination of medical care for the patient.

Responsibility for Dependent Children Over Age 18

• Responsibility After 18: When your child reaches 18 years of age, you will continue to be responsible for their financial obligations unless you provide written notice to Bright Future Pediatrics that you are no longer responsible before services are rendered.

Policy Continuation and Revocation

This financial policy will remain in effect until revoked in writing.
Last Updated: 09/2022