Form – Office Policies

Appointments

• We DO NOT accept walk-ins; please call for all appointments.
• If you no longer need your scheduled appointment, we required that you give our office 24 hours’ notice. Failure to do so will result in a $25.00 missed appointment fee.
• If you cancel an appointment that was scheduled on the same day, please call and cancel the appointment within 4 hours of your appointment or you will be charged a missed appointment fee of $25.00.
• If your child’s appointment is scheduled on a Monday and you need to cancel after normal office hours. You may send an email or you may call and leave a message with our answering service.
• If your child is under the age of 18, a parent; guardian or authorized person must accompany your child for all visits.
• If you are more than 15 minutes late your appointment may be rescheduled. You will be charged a $25.00 missed appointment fee.
• IF YOU ARE GOING TO BE LATE, PLEASE GIVE OUR OFFICE A COURTESY CALL TO LET US KNOW .
• Our providers ARE NOT contracted with CCS. Therefore we cannot treat your child if they have a CCS illness.

Insurance

• Our office accepts most PPO insurance policies.
• Our office accepts GEMCare or Golden Empire Management HMO
• Our office accepts Kern Family Health Care.
• If we are not contracted with your insurance, we will collect the out of network benefits at the time of the appointment.
• It is the parent’s responsibility to know your insurance benefits and what services are covered and noncovered benefits.
• If for any reason your insurance company does not pay for your child’s office charges, you are responsible to pay upon receipt of notification.
• Co-payments are due at check-in.
• If your insurance changes in any way, it is the responsibility of the parent to notify our office immediately.
• Parents are to respond to any insurance questionnaires or denials within 3 days of said documents.
• We do not bill automobile accidents. You will be required to pay for services rendered at the time of services.
• If you do not have insurance or if we are not contracted with your insurance carrier, payment for any service must be paid in full at time of service, including any outstanding balances.

Parental Responsibility

• If there is a court order in effect, it is the responsibility of either parent or guardian to provide our office with the most recent judgement. It is not our responsibility to inform either parent of the office visits that their children are brought in for.
• We do not get involved with custody cases, whom ever brings the child in for service is required to pay the balance (if any) on the account and co-pays, deductibles, co-insurance at time of services.

Change of Personal Contact information

• It is the responsibility of both parent’s to provide our office with any change of address and/or phone numbers immediately.

Account Balances

• Payment for your account balance is due upon receipt of statement.
• If your child is scheduled for ANY visit and you have an outstanding account balance, you will be required to pay any prior balance in full.
• If your account balance becomes over 120 days past due, your account will be sent to collections. Once you have been sent to collections your child/children will be discharged from the practice and you will have 30 days to find another physician.
• It is the parent’s responsibility to respond to your insurance inquires in a timely manner to avoid any billing delays, otherwise office charges will be the parent’s responsibility.
• Cash pay accounts are due in full at time of service.

Payment by Check

• If you write a check payable to Okezie Pediatrics, you will be required to show a valid California ID or a valid California Driver’s License.
• We do not accept out of area checks, third party checks, etc.
• We do not accept unprinted checks.
• If your check is returned unpaid for any reason, we will no longer accept any check on your account. A $35.00 returned check fee will be added to your account balance.
• Failure to pay for an unpaid check will result in your check being turned over to the District Attorney’s office and incur additional fees. Once your check is sent to the DA’S office we will not accept payment for your returned check in our office, you must pay the DA’s office directly. No appointments will be made until the DA’s office has been paid in full.

Insurance Coverage for Newborns

• Not all insurance companies automatically cover your newborn baby. It is your responsibility to understand the process required by your insurance plan to add your newborn to your policy. Our office will assist you in any way we can.
• If you DO NOT have automatic newborn coverage for your baby, then parents will be required to pay 100% of office fee at the time of service. Contact our billing department when you enroll your newborn to discuss reimbursement.
• Kern Family Health Care newborns need be added to Kern Family upon delivery. If mother is eligible with Kern Family, your newborn qualifies for automatic newborn coverage during the month of birth and the following month. Parents are required to enroll their newborn to insure continued coverage. Otherwise the coverage will be terminated.

Appointment Waiting Time

• We have 2 Providers treating patients on a daily basis. Depending on their schedules it is possible for another patient who signed in after your child to be called back to a room before your child. Their appointment is possibly with a different provider than the one seeing your child. We appreciate your patience.
• Please be aware that we may have to treat according to the gravity of the situation. This may prolong your waiting time. We appreciate your understanding.

Medical Records

• If you would like a complete copy of your child’s medical records to be sent to another doctor we ask that you allow 5-7 business days from the time you turn in you completed Release of Records form.
• If you would like a copy of your child’s medical records for your personal records, please allow 5-7 business days from the time you turn in your completed Release of Records, also there will be a $25 for the first 50 pages and a $.10 charge for each additional page, charge per child. We do not email any medical records.
• You can access your child’s medical records for free by going to our Patient Portal.
• If you request a copy of your child’s immunization record or past physical form, please allow 3-4 days from the date requested.
• There will be a $5 charge for new immunization records
• ALL medical records requested by your new pediatrician will be faxed. ALL records requested by parents must be picked up.
• There will be a $25 fee for ALL letters and insurance forms that need to be completed.
• There will be a $25 fee for ALL letters and insurance forms that need to be completed.