Fairfax Pediatric Associates, PC
Comprehensive Health Care for Infants, Children & Young Adults
(703) 391-0900

2010 FPA Financial Policies

2010 FPA Financial Policy Form

Failure to Keep Appointments

 If you can not keep your appointment, notify the office 24 hours PRIOR to your scheduled appointment to avoid a fee.
There will be a $25.00 charge for all missed nursing appointments.
There will be a $50.00 charge for all missed sick appointments.
There will be a $100.00 charge for all missed Well Care appointments.

After-Hours (5PM-7:30AM) Phone Calls 

Effective January 1, 2010, Fairfax Pediatric Associates will be charging $15.00 for all after-hours phone calls.  Rising expenses for after-hours phone call services have made it too difficult to continue offering this service for free in the evenings. 

Developmental, M-Chat and Other Screening Tests

 During your child’s well exam, the Doctor/NP will ask you questions about and observe the development of your child. They will also complete a computerized developmental screening test. You will complete an M-Chat questionnaire to identify possible autism characteristics during the 18 month and 2 year well-exam.

 Use of these developmental and autism screening tools will help with the early diagnosis and treatment of developmental problems.

 The Well Child Examination only includes the physical exam and preventative guidance.

Other services such as: immunizations, vision screenings, hearing screenings, M-Chat and developmental screenings are charged separately.

 Please be aware that your insurance may not cover these screening tests and the charges may become your responsibility.

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. Co-Pays not paid within 24 hours of the visit will incur an additional charge of $25.00.

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.