Payment for services of charges for services are described in our fee schedule which can be obtained upon request. For your convenience, we accept Visa card, MasterCard, and Discover card. It is important that you become familiar with the provision of your insurance coverage with respect to your payment responsibilities. Coverage varies with all insurance plans and may not be guaranteed. Some plans only cover services rendered at certain hospitals, labs, and outpatient facilities. IT IS YOUR RESPONSIBILITY TO KNOW IF YOUR INSURANCE PLAN COVERS WELL EXAMS AND IMMUNIZATIONS, AND WHAT AMOUNT ($) OR PROPORTION (%) OF YOUR CHARGES THE INSURANCE PLAN COVERS. Oftentimes, insurance plans provide limited coverage/benefits on these services. If PTP has to call your insurance company regarding the benefits of your insurance plans, it cannot guarantee the benefits that are stated to its staff. You will, therefore, be responsible for all non-covered services rendered by PTP during your visit and at the time of the service.
PTP WILL SUBMIT CLAIMS TO INSURANCE COMPANIES THAT IT IS CONTRACTED WITH. Payment is required in full for all co-pays, deductibles, and all outstanding/past due balances at the time you sign in for your appointment. There will be a $10.00 fee assessed for any co-pay or balance not paid (in full) at the time of service. PTP will not be able to see your child/children if you are on one of the HMO plans with which it is not contracted. You must see the provider listed on your card. However, PTP may be able to see you if you are on a PPO/EPO plan or on an indemnity plan ONLY.
PTP will bill your secondary insurance as a courtesy, only if it is a contracted provider. If payment from your secondary is delayed by our insurance company for over 60 days for any reason, it is your responsibility to make payment arrangements on your account.
You are required to fill out complete paperwork once a year, or whenever there is a change in insurance, insurance plan/coverage, address, telephone number(s), contact information, and any other relevant information.
PTP charges a $35.00 fee for returned checks. Upon your third returned check, you will be required to make payments for all future services ONLY by cash, money order, or credit card.
You can be given a replacement shot record but there will be a $20.00 processing fee for any subsequent/additional copies. Please keep your original record in a safe location. Your child will need a copy when entering school or college. There is no fee whenever a card is brought in to be updated. PAYMENT HISTORY: A summary of your account, (for all children linked to the same guarantor), is available to you once a calendar year at no charge. For any additional request during the calendar year, there will be a $5.00 processing fee.
Co-pays and outstanding payments are due at the time of service. There will be a $10.00 fee for any co-pay or balance not paid on the day of service by 5:00 pm.
The 1st (first) copy of your child’s medical records will be given to you at no cost. For any additional/subsequent copies, a $30.00 fee will apply. There will be no charge for records requested directly by your insurance company or by a specialist that we have advised to see your child. Records will not be faxed. You can either pick up your records or have them mailed to you at the address on file (unless otherwise advised). Please be advised that there is a $5.00 fee for any record mailed to you.
There is a $10.00 fee for each child or for each form that needs to be completed. Please make sure to have the employee requesting FMLA sign the appropriate pages so that we may forward it to your work by fax. Please make sure to bring any physical/sports forms at the time of your exam. There is no charge if completed at the time of the visit for the physical/sports examination.
A $50.00 fee will be charged when a scheduled appointment is not canceled or re-scheduled 24 HOURS or more prior to the appointment time.
*ALL OF THE ABOVE RECORDS WILL BE PREPARED WITHIN 7-10 BUSINESS DAYS UPON RECEIPT OR PAYMENT. RECORDS FOR PATIENTS THAT HAVE NOT BEEN TO OUR OFFICE IN OVER 3 YEARS MAY TAKE AN ADDITIONAL 5 DAYS TO PROCESS. IF YOU HAVE ANY QUESTIONS REGARDING YOUR ACCOUNT, PLEASE CALL PTP's BILLING DEPARTMENT AT 623-255-7413.
Mask are now optional inside Palm Tree Pediatrics. Sick children may be required to wear a mask.