Policies & Procedures

At Next Generation Pediatrics, every member of our staff is committed to providing the highest quality healthcare for your child.

As a part of this, we ask that every family we support has a clear understanding of our financial policy and procedures so you will know what actions our team will be taking on your behalf as well as what your responsibilities are.

New Patients

Upon registering your child, we will need the following information and items: Insurance Information; the name, date of birth, social security number and address of the insurance cardholder; the patient’s address, date of birth, and social security number; contact information for both parents and/or guardians.

Insurance

Our team will need to verify your insurance information whenever you are scheduling an appointment. You must bring your current insurance card with you for each visit and for each child. We no longer accept the Access card. It is your responsibility to notify our staff of any insurance information changes. We encourage you to refer to your benefits manual or contact your insurance carrier if you have any questions regarding your coverage.

Attention Parents:

The American Academy of Pediatrics, Bright Future guidelines, recommends certain screenings be done at child well exams.  For the health and well being of your child, the doctors perform the recommended screenings (whether it be a TB, lead, vision, hearing, depression, developmental, etc.) that are age appropriate and recommended.  Due to the Affordable Care Act, providers are also required to report all services provided at each visit.  We have reported this information and billed your insurance company accordingly for services rendered as part of the child’s well visit. However, issues we have run into with the insurance companies are:  there are many codes billed at the well visit that are not considered part of their “preventive” list of codes under your plan or “preventive grid” based on their guidelines of the Health Reform Act.  The insurance companies follow the CMS guidelines / Health Care Reform Act and there are some codes that fall under your regular medical benefit plan vs your preventive plan.  For more information on your insurance company’s guidelines, you should call your insurance company and discuss your plan’s reimbursement policy.

Co-Payments

Your co-pay is due at the time of your visit. We accept cash, checks, Visa, MasterCard, Discover and Health Savings Accounts. If you are unable to pay at the time of your visit, prior arrangements must be made. A $10.00 fee will be assessed for any co-pay amounts that are not paid at the time of your visit.

Self-Pay Patients

If you do not have insurance to cover the cost of your child’s visit, you must pay in full at the time of the appointment. We accept Visa, Mastercard, Discover, cash, checks and Health Savings Accounts.

Appointments

Acute/sick issues are scheduled on the same day or within 24 hours. All well child visits are scheduled in the first available opening. We also have special times set aside for more complicated issues, such as behavioral concerns.

Attendance of Visits

A parent or guardian must be present at each well visit. A representative may bring your child to a sick visit if the following items are brought with the child.

  • A signed release by the parent or guardian
  • Current complaint, symptoms and concerns
  • The child’s insurance card and co-pay

Be sure to bring a current list of all medications with you to each visit. Also, bring your baby book so that we can be sure your child is current with all vaccinations.

Arrival

Please arrive 10 minutes prior to your appointment to check-in. If you are more than 15 minutes late from your scheduled appointment time, you will not be able to be seen at that time and will have to reschedule.

Missed Appointments

We require 24-hour notice for any appointment that you are unable to attend. If your child misses 3 appointments without notifying our office in advance, your child will be discharged from the practice.

Patient Forms

There is a $10.00 fee for all physical forms not presented to the staff at the physical appointment. This $10.00 fee must be paid at the time the form is dropped off at our office. There will be a $20.00 fee for any form needed the same day it is dropped off to the office.

After Hours

Help is always available after the office has closed. When a situation arises, call our office number, 724-482-2220. If necessary, the physician on-call can be contacted to help you. If you are in a life-threatening situation call 911, do not take time to call the office.

After- Hour / Weekend / Holiday Code

The evening code 99051 is a billable code allowed by insurances.  This code is to be applied to all 5:00 pm or later, weekends, and holidays appointments.  

We are obligated, via our insurance contracts, to accept the amount insurance pays and also to charge the patient the amount insurance determines.  Patients are legally obligated, via their insurance contracts, to pay the balance.  Depending on the patient’s insurance plan, you may be responsible in whole or part for this service.

When your Child is Sick

Call our office to either directly schedule an appointment or speak with a nurse who will discuss your child’s symptoms and identify if and when your child needs to be seen in the office. Appointment requests and nursing advice may also be submitted through our patient portal.

Billing

Next Generation Pediatrics handles all of its own billing. When you have a billing issue, simply call our office and ask to speak with our billing manager. Your request will be handled in-house with the same staff member each time.

Late Payment Fees

A fee of $20 will be assessed on accounts that are 60 days past due. An additional fee of $50 will be charged to accounts that are 90 days or more past due.

**Any account balances over 90 days old will receive a certified letter and will need to be settled in 10 days.  If payment is not received or arrangements made, we will assume you no longer want to have your children seen at Next Generation Pediatrics.  Your account will be sent to collection, and all legal fees and collection expenses will be added to your balance.  By law, we will continue to provide emergency care for 30 days from the date of notice.  Should a patient need non-emergent medical attention in those 30 days, you will be required to settle your account prior to the visit.**

Returned Checks

There is a $30.00 fee for all returned checks.

Referrals

Please call our office as soon as your appointment for a specialist is made. We ask that you give a minimum of 2-3 business days to complete referrals.

Medication Refills

When your child needs a refill, call our office. If your prescription can be sent to a pharmacy, our office will electronically send a refill to the pharmacy of your choice. Your request will be completed within two business days. So, be sure to call before your refill is needed. Refill requests received by 3:00pm through our patient portal are generally filled the same business day.