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Carlisle Pediatric Associates
 
Specializing in the care of infants, children and adolescents.
 
 
 
 
 
 
 
 
 

Office Policies/ New Patient Downloadable Forms

VACCINATION POLICY – PLEASE READ

EFFECTIVE 1-1-2017 we will require that any patient under our care receive the immunizations required by Pennsylvania schools in the recommended time frame, or we will no longer be able to care for your child at this office. (complete policy available to view at the right or in our office)

INSURANCE GUIDELINES - please confirm with your insurance company if they consider us a participating doctor.

Please bring your insurance card to every visit.
You will need to present your card at every visit because our contracts with insurance companies require us to validate your coverage each time we see you.
WE MUST HAVE A COPY OF YOUR CURRENT INSURANCE CARD ON FILE IN ORDER TO SUBMIT CLAIMS. If we are not given a valid insurance card you will be considered “Self Pay”.
CURRENT INSURANCES WE ARE PARTICIPATING WITH:
(this list can change due to contract negotiations)
  • CAPITAL BLUE CROSS
  • KEYSTONE
  • HIGHMARK BLUE SHIELD
  • P.H.C.S.
  • HEALTH AMERICA
  • HEALTH ASSURANCE
  • TEAMSTERS PRIME SOURCE
  • AETNA
  • CIGNA
  • ACCESS
  • GATEWAY
NO OTHER Access HMO plans are accepted except Gateway.
**Any patients with an HMO PLAN (including Gateway)**
Our name must be on your card to receive care. You MUST call your insurance and add us as your child’s Primary Care Physician prior to being seen. Newborns have 30 days to have us added as PCP.

FINANCIAL POLICY - please review COMPLETE policy in our office or download policy.

We are committed to providing you with the best possible care and we will gladly discuss our professional fees with you at any time. Your clear understanding of our Financial Policy is important to our professional relationship. Please ask if you have any questions about our fees, Financial Policy, or your responsibility in regards to your services.

YOUR PORTION OF THE BILL IS DUE AT THE TIME OF SERVICE.

Including: Co-Pays, Deductibles, Non-Covered Services, Non-Par visits, etc.

WE ACCEPT CASH, CHECKS, VISA, DISCOVER AND MASTERCARD

If you do not pay at time of service there may be a billing fee assessed.

If you have insurance, we will assist you in receiving your benefits. Any insurance claim will only be submitted if we are furnished FULL insurance company information needed. Please be aware insurances mandate a time frame for filing insurance claims.

If we do not receive insurance information within 45 days of the date of service no claim will be filed and you will be responsible for payment.

Please verify with your employer or insurance company if we are participating with your specific plan BEFORE scheduling appointments.

We will not become involved in disputes between you and your insurance company regarding deductibles, co-payments, covered charges, secondary insurance, “usual and customary” charges, etc., other than to supply factual information as necessary. You will need to resolve these with your insurance.

YOU ARE RESPONSIBLE FOR THE TIMELY PAYMENT OF YOUR ACCOUNT.

YOUR INSURANCE IS A CONTRACT BETWEEN YOU AND YOUR INSURANCE COMPANY.

Please be advised that you are initiating services to be rendered and ultimately you are financially responsible for all charges incurred whether paid by your insurance or not.

REFERRAL PROCESS POLICY - please review COMPLETE policy in our office or download policy.

Many insurance plans, especially capitated plans such as Aetna HMO, Keystone Health Plan Central, and Gateway have complicated rules regarding specialist visits and referrals. Even within the same insurance company, policies and procedures may vary from one employer to the next.

When you need to visit another doctor or facility, it is your responsibility to know your specific benefits. YOUR INSURANCE IS A CONTRACT BETWEEN YOU AND YOUR INSURANCE COMPANY. If you are unsure, you can get more information by calling the member services number on the back of your insurance card.

If your insurance plan does need referrals, our office policy requires a minimum of two (2) business days to process a routine referral. We recommend that you contact us as soon as you make an appointment with a specialist. We cannot “back date” a referral.

If you were already seen by a specialist without a referral, we will not be able to process one after the fact.

If you call us on the way to the specialist, or while at their office for your visit, we will not be able to process your request in time for your scheduled visit. You may be asked to reschedule the appointment if the specialist cannot verify that you have a referral in the system. If you need to see a specialist for a follow-up appointment, inquire if you will need an additional referral or if the original referral included a certain number of follow-up visits within a defined period of time.

If you would like an “non-par” referral (to visit a specialist or facility that is out-of-network), we require 5 business days to handle such requests.

NO SHOW POLICY - please review COMPLETE policy in our office or download policy.

The relationship between doctor and patient is a two-way street. There are rights and responsibilities on both sides. When you make an appointment to see one of our doctors or our physician’s assistant, that time is set-aside just for you. We attempt to confirm appointments a day in advance but ultimately you are responsible to mark your calendar to assure you are available to keep the appointment.

We do understand there could be a circumstance when you are unable to arrive for appointments. However, if this becomes a pattern for your family’s appointments, there will be consequences involved. If you have missed an appointment in our office we ask you to be sure to keep future appointments or cancel them with a two-hour advanced notice to avoid being considered a “no show”.

Last minute cancellations still result in lost appointment times.

We do require a 2-hour notice to cancel appointments.

Less than 2-hour notice will result in a “no show” fee of $20.00 assessed to your account.

If you do not keep an expanded visit, such as a consultation or Complex check-up there will be a $50.00 fee for the lost visit.

If your family has had 3 no show appointments within a year, or an excessive amount compounding over the years, you may be asked to find another practice that better meets the needs of your schedule.

 
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