Policies

Late & Cancellation Policy

We are always looking forward to a visit with your kiddos here at ABC Pediatrics. However, we understand that unexpected things can happen, and appointments sometimes need to be rescheduled.

If you are more than 15 minutes late for your appointment you may be required to reschedule to a later date.

If you need to reschedule your appointment, please give us as much advance notice as possible. This gives us the best opportunity to schedule another patient during that time. If you cancel or reschedule your appointment less than an hour in advance, a cancellation fee might be applied. After repeated last minute cancellations or rescheduling of appointments, we retain the right to recommend that you see another pediatrician.

No Show Policy

If your child has more than three no-shows we reserve the right to terminate care to your family. We would continue to provide medical care for sick appointments only for 30 days, providing you time to locate another primary care physician. There will be a fee of $25.00 added to your account for a no show.

Transfer In/Transfer Out Policy

We are always excited to welcome new patients to ABC Pediatrics!

If you are new to the area or expecting a new family member, please call our staff at (828) 277-3000. They will begin the registration process. We will need all vaccine and medical records for your child. If you don’t have them, don’t worry – you can sign a medical records release at our office, fax or email it, or submit it through our Portal, and we can request them from your previous provider.

If you are relocating or your child is aging out, please submit a request for medical records release at our office or through our Portal, and we will forward them to your child’s new provider.

Age Out Policy

ABC Pediatrics is proud to provide the very best possible healthcare for your children. We are also committed to supporting our patients as they transition to adult care.

As your child nears their 17th birthday, you will receive a letter reminding you that we will be happy to provide them care through their 18 year well check following their 18th birthday.

As they approach their 18th birthday, both they and you will receive a letter reminding them that we will see them for their 18 year well check while recommending that they begin transitioning to an adult care provider for all future appointments.

Billing Policy

We are committed to providing you with quality health care. We have developed this payment policy to help answer questions you may have regarding the payment and insurance responsibility for services rendered. Please read it, ask us any questions you may have, sign in the space provided, and return to us. A copy will be provided to you upon request.

Proof of Insurance and Eligibility You must present your insurance card at EACH visit. Phreesia will attempt to access eligibility, co-pay, co-insurance, and deductible information. We will also ask to verify your insurance and scan your insurance card upon EACH visit to our office. If you do not have current insurance information, you will be required to pay for the services rendered until a copy of your current insurance card is obtained. We charge $100.00 for a sick visit and $200.00 for a well check visit. We also encourage each family to call and find out their specific benefits for their policy because it is ultimately your responsibility to know and understand your own insurance coverage.

Insurance Participation We have contracts with and file claims for the following insurance companies: Aetna, BCBS, CIGNA, Crescent, GEHA, Medicaid, United Health Care, Golden Rule, UMR, Healthscope, Healthgram, Humana, Federal Blue Cross, and Medcost. We can provide you with information to file your insurance if you are out of network. You will need to check with your individual policy to see if we are in network with your particular carrier or if the service you need is covered.

Assignment of Benefits I hereby assign all medical and surgical benefits to include major medical benefits to which I am entitled. I hereby authorize and direct my insurance carrier(s) to issue payment check(s) directly to ABC Pediatrics of Asheville, PA rendered to me and/or my dependents regardless of my insurance benefits, if any. I understand that I am responsible for any amount not covered by insurance.

Claims Filing We will file claims for those insurances with which we are contracted, as well as secondary insurance. We accept the contractual write-off based on your primary insurance. Once we have received instruction from your insurance company, you will receive a bill for any outstanding balance. You will then be responsible for that balance. We can provide you with information to file your own insurance if we are not in contract.

Non Covered Services It will be the responsibility of the family to know your benefits. You will be responsible for non-covered services. Some common services that are not covered are the afterhours charge, developmental screen, vision, hearing test, and depression screen.

Keep Us Informed Most often errors in billing and claims payment are related to incorrect information. Please update us with name, address, email address, phone number and insurance information as it changes.

Payment We accept Checks, Cash, Discover/Visa/MC/American Express and Debit cards. We also accept Care Credit. You may pay your co-pay or previous balance on the Phreesia tablet while checking in for your visit. All payments for service are due on the day the service is provided, unless other arrangements are made with our business office 828-277-3000 X 324 or 326. You will be required to store a credit card on file for future payments. If a payment plan is required for an outstanding balance, an auto-draft payment plan will be set up until balance is satisfied. You may apply for Care Credit on our website. We also offer online payments on our website on the home page at www.abcasheville.com.

Self Pay Discount We offer a self-pay discount of 30% if you do not have insurance to file. The visit must be paid on the same day as the patient’s service is rendered. We do not allow patients who have insurance to use the self pay discount as an option if you have high deductible or high copayments.

Co-Payments Many plans require that a patient pay a co-payment at each visit. We are bound by our contracts with insurance companies to collect that co-payment at the time we render our services. In keeping with our contracts, we will collect your co-payment when you check in. Please help us in upholding the law by paying your co-payment at each visit. We will charge $10.00 for each co-payment that is not paid on the date of service. This will be added to your monthly statement.

Statements Once your statement reflects that your insurance has paid you must pay your portion for that date of service. You will receive only two statements. If payment is not made after the second statement, you will receive a collection letter. We reserve the right to terminate our patient relationship for non-payment of services.

Check In and Proof of Identity Check in is now performed on a Phreesia tablet. All patients must complete patient information, demographics and clinical information before seeing the doctor. You will receive a reminder email 3 days prior to your visit and may complete your check in online. You can even complete all questionnaires online. Mention that you have previously checked in to the receptionist. You must provide us with a current copy of your insurance card at each office visit. We may also ask you to provide us with a copy of your driver’s license or other photo ID. Due to Insurance filing we do require the social security numbers of both parents. Also parents or legal guardians must be present for office visits of a minor.

Patient Refunds Refunds will be reviewed on a per claim basis. Upon confirmation and approval of refund, check will be issued to account holder or credit refunded to your card.

Returned Checks We charge a $25 fee for returned checks. Patients who have written more than one returned check will be required to pay by cash or credit card. Multiple returned checks may result in discharge from the practice.

Delinquent Accounts We will make attempts to contact you by phone, email and by mail regarding delinquent accounts. Failure to pay will result in accounts being turned over to our contracted collection agency in 90 days from the date of service. If your account is turned over, we will no longer offer medical care to the guarantor of the account or any family members for whom that guarantor is responsible. We will see your family for 30 days after termination date, for sick visits only. This will allow your family time to find another provider for medical care. If your account is turned over to collections, a $25.00 fee will be assessed.

Charge for Medical Records Medical records requested will be copied for the following fee: $15.00 for 20 or more pages, per family.

Night/Weekend Charge We charge an additional $45.00 for our services on holidays, weekends and also in the evenings after 5:00 P.M. check your insurance coverage for this charge.

Custody/Payment Issues Due to the many complicated issues that arise due to custody and payment issues, it is our office policy that payment is expected by which ever parent is bringing the child to the appointment. The parents can then work out an agreement for repayment amongst themselves.

Code of Conduct

ABC Pediatrics strives to provide a safe and healthy environment for staff, visitors, patients, and their families. We expect visitors, patients, and accompanying family members to refrain from unacceptable behaviors that are disruptive or pose a threat to the rights or safety of others.

The following behaviors will not be tolerated and may result in a person’s removal from the facility and dismissal from the practice:

Inappropriate behaviors in person, on the phone, or through written communication, including but not limited to the following: profanity, harassment, and threatening or aggressive behavior.
Physical assault, theft or intentional damage of equipment or property.
Behaving in a manner as if under the influence of drugs or alcohol.
Racial or cultural slurs or any other derogatory remarks associated with race, language, religion, or sexual orientation.
Requests that would constitute illegal or unethical behavior on the part of ABC Pediatrics.