OFFICE POLICIES

Our practice is committed to providing you with the best care possible. Letting you know in advance of our office policies allows for good communication and a better physician-patient relationship. Please read carefully and if you have any questions, please do not hesitate to contact our office manager.

Appointments

We value the time we have set aside to see and treat your child. If you are unable to keep your scheduled appointment, cancellation at least 24 hours  prior to the appointment is required. This will allow us to reschedule your appointment and utilize that time to provide care to another patient. We reserve the right to charge $25.00 for missed appointments. After three missed appointments by a family within one year, you will be at risk of being discharged from the practice due to failure to comply with a medical care plan.

If you are greater than 10 minutes late for your appointment, we will do our best to accommodate you. However, it may be necessary to reschedule your appointment due to time constraints.

We strive to minimize your wait time, however, unexpected situations do arise for patients. We appreciate your understanding.

Insurance

It is your responsibility to provide us with current insurance information and to present an active insurance card at each visit. If your plan requires, you must name a physician from Middleboro Pediatrics as your primary care provider. Failure to do so will result in you being financially responsible. If you are a MassHealth PCC Plan policy holder, you must name Middleboro Pediatrics as your primary care office.

It is your responsibility to understand your benefit plan with regards to covered services, referrals and pre-authorizations. For example, not all plans cover annual well-child or sport physicals, hearing and vision screenings.

Advance notice is required for all referrals, typically 3-5 business days. It is your responsibility to see if a specialist participates in your plan. We must approve all referrals before they are issued.

FINANCIAL

In accordance with your insurance plan, co-payments are required at time of service. We accept cash, check and most major credit cards. A $5.00 service fee will be charged in addition to your co-payment if it is not paid at the time of your visit. You are responsible for all deductibles and coinsurances.

Self-pay patients are expected to pay for services in full at time of visit.

A $5.00 fee will be charged for any checks returned for insufficient funds, plus any bank fees incurred.

Balances are due within 30 days. A request for payment letter will be sent for balances more than 60 days. A final request for payment letter will be sent for any balances outstanding longer than 90 days. If your account is forwarded to our collection agency, we will continue to see you on an emergency basis only for the next 30 days while you arrange for another physician to assume your care.

If special circumstances make immediate payment impossible, alternative payment arrangements may be discussed with our office manager.

Should your account balance become uncollectible due to bankruptcy, we will continue to see your child on an emergency basis only for 30 days, giving you time to find a new source of medical care.

FORMS AND FEES

Your child’s school form is provided at no cost. Please keep the original form.  You may photocopy it as needed for additional activities such as camp and sports. This form is good for one year from your child’s last physical.  Patients with online portal access can also access forms as needed.

If transferring to another physician a single copy of your complete medical record is provided at no cost.  A signed medical records release authorization form must be received before forwarding a copy of your medical
record.

Any additional copies of forms are subject to $0.50 per page for the first 100 pages and $0.25 for each additional page in excess of 100 pages.

There is a base fee of $15.00 for those records requested by any agency or attorney for the cost of labor, supplies and postage.

Please allow 5-7 business days for the completion of all forms and transfer of medical records.