Financial Policy

Thank you for choosing our practice for your child’s healthcare needs. We are committed to the success of their medical treatment and care. Please understand that payment of services is considered part of treatment. The following explains our Financial Policy:

  • The parent/guarantor should provide accurate and complete personal and insurance information for the patient prior to being seen by the provider. It is the parent/guarantors responsibility to update any changes in insurance, home address, or contact information.
  • All applicable co-pays, co-insurance, balances due, both current and prior, are due at the time of service.
  • We accept cash, personal checks, and most major credit/debit cards.
  • If we are unable to verify the patient’s insurance at the time of service the parent/guarantor will be asked to pay for the amount due for the visit.
  • Regarding Insurance

If the patient is covered by health insurance, it should be understood that this is an agreement between the parent/guarantor and their insurance company. As a courtesy, we will bill the insurance company for all covered services. The parent/guarantor will be responsible for any bills that are not paid within 30 days of our claim submission. The parent/guarantor is responsible for payment of the patient’s bills regardless of the status of the insurance claim. We believe our fees to be customary for our region and specialty. If the patient’s insurance company uses a different fee schedule, the parent/guarantor will be responsible for any balance remaining.

Contract Insurance: If the patient has insurance coverage our office has contracted with, the parent/guarantor will be asked to pay all co-pays, deductibles, and any non-covered services at the time of service. Please verify with our receptionist if we are a “participating provider” with the patient’s insurance plan. It is the parent/guarantor’s responsibility to be familiar with the guidelines of the patient’s insurance coverage and benefits.

Non-Contracted Insurance and Non-Covered Services: If the patient has insurance coverage our office is not contracted with “non-participating”, payment is due at the time of service and the parent/guarantor will be given a receipt to file with the insurer. Services we provide to the patient may or may not be covered by their insurance due to routine, non-covered, or medically unnecessary services. In the event that the patient’s insurance company does not cover services, the parent/guarantor will be responsible. In some cases a pre-certification may be requested from the insurance carrier, but this does not guarantee payment.

Medicaid: We are participating providers with Georgia Medicaid. The Parent/guarantor is responsible for co-payments at the time of service. If the patient exceeds the allocated 12 visits for the year, the parent/guarantor will be held financially responsible.

Cancellation Policy: A $25.00 Charge will be added to the patient’s account if an appointment is not cancelled 24 hours in advance. The appointment may be cancelled by calling 706-208-3715.

Self Pay: Patients who do not have health insurance are considered “Self Pay”. Payment is due at the time of service. We offer a 25% discount off the office visit charge when paid in full at the time of service. This does not include other procedures performed, such as labs, x-rays, etc.

Auto Accident Related Visits: Parents/guarantors of patients being seen for automobile accident related issues must provide automobile insurance information and/or claim information to the visit. Parents/guarantors are expected to pay for their visit up front, and will be reimbursed if their visit is paid by their motor vehicle accident insurance carrier.

Past Due Accounts: Unfortunately, we are not in the position to finance health care and we make no arrangements for long term payments on patient balances. If unusual circumstances should make it impossible for the parent/guarantor to meet our credit terms, we ask that they call 706-621-7575 or personally discuss the matter with our financial coordinator. This will avoid any misunderstanding and enable the patient’s account to remain in good standing. Accounts will be referred to our collection agency if an agreement to pay is not reached within 90 days of the initial statement date.

Returned Checks: There will be a charge equal to Georgia’s highest allowed fee added to the patient’s account for any check returned for non-payment from the bank. Please contact our financial coordinator at (706) 621-7575 if there are any questions or concerns.

Refunds: Refunds can take 45-60 days to process.

Finance Charge: There will be a $10.00 finance charge accrued after 2 statements have been mailed.

This form is intended for non-patient related questions. For any patient related needs or to schedule an appointment,
please call (706) 621-7575

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