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Financial Policies
CO-PAYS
The patient is expected to
present an insurance card at each visit. All co-payments and past due
balances are due and payable at the time of service.
SELF-PAY ACCOUNTS
Self-pay accounts are patients
covered by insurance plans in which FPA does not participate, patients
without an insurance card on file, or patients who do not have any
insurance coverage. The parents shall pay in full at the time of
service.
NON-PARTICIPATING INSURANCE
PLANS
FPA will file to these
insurance plans as a non-assigned claim as a courtesy to our patients.
The parents shall pay in full at the time of service. The insurance
company will reimburse the parent on non-assigned claims. If the check
is received by FPA, it will be endorsed and forwarded to the parent,
providing the account balance meets the required criteria.
PATIENT REFUNDS
The following criteria must be
met prior to issuing a patient refund: there are no outstanding
insurance claims on the family's account, and there are no outstanding
patient balances on the family's account.
PAYMENT PLAN AGREEMENTS
FPA is willing to extend
payment plan agreements to patients with special financial needs. Each
agreement is unique and personalized to each family's situation and is
arranged through Fairfax Pediatrics' billing office. Please contact us
if you are in need of special arrangements.
DUAL INSURANCES
If both parents have insurance
coverage, the primary insurance is determined by the fifth Birthday rule In
Virginia, the dependent children are covered first by the health plan of
the parent whose birthday falls earlier in the year. The other parent
holds the secondary Coverage.
CHILD CUSTODY CASES
The parent with primary
custody is usually the parent with whom the child lives and who usually
brings the child to FPA for care.
The custodial parent is
responsible for co-payments at the time of service for participating
instances and for all past due balances. If the non-custodial parent
carries the insurance, FPA will bill that insurance company. FPA does
not get involved with divorce settlements, e.g., one parent pays 80% and
the other parent pays 20%. It is the parents' obligation to work out an
agreement and insure prompt payment to FPA.
REFERRALS
If your insurance requires you
to designate a primary care physician (PCP), you are required to have
authorization from us, your PCP, PRIOR to having a specialist
appointment. We require 5-7 working days for routine referrals to be
processed. Emergency referrals will be handled on a case by case basis.
Do not call us from the specialists' office, if you have not been
referred by your PCP, to authorize a referral. You may either reschedule
your appointment or self-refer, and pay the specialist fees at the time
of your visit.
This financial policy helps
FPA provide quality care to our patients. If you have any questions or
need clarification of any of the above policies, please feel free to
contact us.
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