FINANCIAL POLICY

Thank you for choosing Coastal Pediatric Associates (CPA) to care for your child. The following is a summary of our financial policy for you to review and sign annually.

INSURANCE

• As a courtesy to our patients, we file claims to your primary and secondary insurance carriers, as long as we are a participating provider.

• Please be sure to bring your insurance card to every visit. If your insurance is ineligible, you will be considered self pay and payment will be due at time of service .

• If an insurance company denies payment on a claim for incorrect/incomplete information or for non-covered services, you will be expected to pay for those services in full. It is your responsibility to follow up with your insurance carrier to correct any additional information they may need.

• Co-payment, deductibles, and coinsurance are due at the time of service. It is your responsibility to know the terms of your insurance coverage, including well-exam visits, immunizations, procedures, lab tests, and medication check visits.

• If we do not participate in your insurance policy be aware your benefits may be reduced.

• We do not file for school or automobile insurance.
  
  Coastal Pediatric Associates, PA does not accept any plans that are designated as healthcare sharing programs. These plans are not considered insurance in the state of South Carolina. For further information, please see our financial policy.

HEALTHCARE SHARING PROGRAMS

• Coastal Pediatric Associates, PA will not submit claims to any healthcare sharing program or any programs that are not legally considered insurance within the state of South Carolina. Under South Carolina regulations, our organization is not obligated to file claims to any healthcare sharing program that is not legally considered to be insurance. Therefore, any acquired charges will be considered patient responsibility and will be due at the time of service. Charges are eligible for the self pay rate. Any payment made at the time of service is an estimated amount and any additional charges will be billed to the guarantor via paper or paperless statement.

• We do not file personal injury or automobile accident claims.

SELF PAY

• Rates when paid in full at time of service:

  • Well Child Check $120: Includes the physical exam, hearing, vision, topical varnish, and other age appropriate screening tests. VFC Vaccine eligible patients will be charged an additional $20 administration fee per vaccine. The number of vaccines administered may vary based on age and vaccine schedule, this amount can be billed to you after checkout.

  • Medication Check $100 (For established patients only)

  • Sick/Office visits: $150 (Follow-up visit within 5 days of the last visit, $75)

  • Vaccine Administration Fees: $20 ea. for all VFC

    • Depo Provera $100.00 for each injection

    • Bicillin $180.00 for each injection

  • *Exclusions/additional charges: COVID testing (any type), RVP testing (any type), GI Panel, STD testing, and Drug Panel Testing
    
    Behavioral Health Services with Mental Health providers have separate costs please contact the office directly.

Immunizations

• If a patient is insured, the immunization(s) given, and administration fee(s) will be billed to the patient’s insurance. If charges are not paid by insurance within 45 days, you will be financially responsible for the balance on the account. If you choose to pay out-of-pocket for the administered immunization(s) given, then a minimum of 50% of the balance must be made at the time of service.

• In some instances, our providers may agree to alter the recommended immunization schedule. If an approved written plan for routine childhood immunizations is established and the parent prefers to follow an alternative schedule, the mutually agreed upon plan will become a part of the child’s medical record.

• A signed statement from the parent stating understanding that the child is not being immunized according to the recommended immunization schedule is completed prior to any alterations to the recommended immunization schedule.

• Variations from the recommended immunization schedule may require additional provider visits to the office and additional insurance co-pays or deductibles. If additional visits are required due to alterations of the recommended immunization schedule, the insurance company may not cover the additional visits and any balances will become patient responsibility.

• Every child may be subject to an office visit with a provider on the same day as any vaccine or injectable medication.

Payments

• Both parents are responsible for all charges regardless of divorce or separation decree.

• Payment of estimated copay, deductible, or coinsurance is due at time of service as required by your insurance company.

• Patients may receive a monthly statement for any unpaid services, after a $10 minimum balance. Statements may stop after 3 billing cycles, but the patient is still responsible for all balances deemed patient responsibility by the insurance company or CPA.

• We accept Cash, Check, Money Order, Visa, MasterCard, Discover and American Express. Please visit your patient portal to view your statement, make a payment and update account information or to ask our Billing Team a question.

• All balances are eligible for collections after 3 statements and are subject to a $10 collection fee.

• Returned checks are subject to a $30 fee. Any account we receive a returned check for, will no longer be allowed to pay by check.

Updated Dec 2020

• Noncompliance/abuse, excessive no shows or failure to meet financial obligations may jeopardize the patient/physician relationship in which Coastal Pediatric Associates will terminate and discharge the patient from the practice. The patient or parent/guardian will be sent a letter of discharge.

Please contact our Billing Department if you have any questions concerning the CPA Financial Policy at 843-573-2535 or utilize the patient portal.