We value you as a patient and look forward to our ongoing relationship with you. Please read each section carefully and initial in the space provided. Our staff is available to answer any questions you may have regarding this document.  

 

1.   Upon arrival please sign in at the front desk and present your current insurance card. This is your verification of an active contract with your insurance company and consent that we bill them on your child’s behalf. If your contract with the insurance company is invalid, you will be responsible for any charges incurred at that visit.  Please notify the office of any change to your insurance coverage.

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2.   If our physicians do not participate in your insurance plan or you do not have insurance, payment in full is expected at the time of service.     

 

3.   Co-payments are due at time of service.  

 

4.   Insurance balances are billed immediately upon receipt of your insurance plan’s explanation of benefits (EOB). Your payment is due within 10 business days of your receipt of the bill.   

 

5.    Patients with an outstanding balance of more than 60 (sixty) days must make payment arrangements prior to scheduling future appointments.

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6.    Contact the office at 202-537-1180 or email billing@foxhallpediatrics.com with questions regarding billing.  

 

7.    Our goal is to prioritize our appointment time with you. As such, we do not double book well-child appointment slots. Therefore, we require a 24-hour notice for canceling any appointments. There is a $50.00 fee for missed well child appointments and $25.00 fee for missed acute care appointments. Late arrivals of 10minutes or more are considered a missed appointment. Missed same-day appointments are also subject to a late cancellation fee.

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8.    A $40.00 fee, plus any bank fees incurred, will be charged for any checks returned for insufficient funds.  

 

9.    We charge $25.00 per child to copy or transfer medical records. These charges must be paid in full before your child’s medical record will be copied and available for transfer/pick up. 

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10.    If your child has school, camp, or sports physical forms to be completed, please let the front desk and medical assistants know at the time of check in. There is $25.00 charge per form. Payment is due when the forms are dropped off.  Please expect a 3-5 dayturnaround time for these forms. If a form is needed sooner than 3 days, there may be an additional rush fee of $10.   

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11.    There may a fee for some for after-hours calls (minimum $35.00).  You may be charged if you are calling for patients over the age of 6 months regarding symptoms or concerns not addressed in the office in the previous 48 hours and/or requesting prescriptions. 

 

12.    Please check with your insurance company before scheduling an annual well child exam. Each plan varies with respect to the allowable interval between well visits. It is your responsibility to know your insurance plan benefits. If the visit is not covered, you will be responsible for payment at the time of visit.  

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13.    Not all services provided by our office are covered by every plan. Any service not covered by your insurance plan will be your responsibility.   

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14.   The doctors will provide you with any necessary prescriptions at the time of your visit. If your child is stable on a chronic medication, they will provide you with a prescription that covers your child until the next appointment. Please allow 3-5 days for the prescription to be sent to the pharmacy. If the prescription is needed more urgently there may be an additional rush fee. 

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Fees are subject to change.