Financial & Practice Policies

We are committed to making your experience as smooth and supportive as possible. Below you will find important information about our financial policies designed to help you understand what to expect and how we can best serve your family.

Insurance

• We accept most insurance plans.

• Proof of current insurance and photo ID are required at EACH visit.

• Please contact your insurance company to understand and confirm your coverage and payment responsibilities.

• The insurance contract is between You and your insurance company.  

  • Our staff does not know the details of your contract.

  • It is your responsibility to update us when insurance coverage changes.

  • We follow recommended guidelines for screenings, but not all plans cover every service -- so it's important for you to know your benefits.

  • Some lab work may be sent to outside labs, for which they may bill you separately.

  • If you need care at an outside facility, please check if it is covered and whether a referral is required.

  • Please confirm with your insurance company that we are in-network with your insurance company and what your out-of-network coverage is.  Any unpaid balance is your responsibility.

Copayments and Deductibles

• Copays and deductibles are due at time of your visit, as required by your insurance.

• High-deductible plans may mean more out-of-pocket costs until your deductible is met.

Newborn Babies 

• Please confirm insurance coverage within 30 days of the baby's first visit. 

• After 30 days, if insurance is not verified, you will be responsible for any outstanding charges.  

Sick visit combined with Well visit 

• Upon examination during a Preventative/Well Child visit, sometimes a child may also have symptoms of illness or an acute issue that needs attention

• In these cases, we'll provide care for and bill for BOTH the preventative visit AND the sick visit -- as recommended by national guidelines from CMS (Centers for Medicare & Medicaid Services) and the AMA (American Medical Association)

• Your insurance may apply a co-pay, co-insurance, or deductible towards the sick visit, based on your plan's terms.

Patients Without Insurance Coverage (Self Pay)

• Families without insurance are welcome.

• Payment is due at the time of service (We can accept Cash, Check, Zelle or most major Credit cards)

Financial Responsibility

• The adult who accompanies the child is responsible for payment.

• The parent is financially responsible once the child turns 18 unless notified in writing.

• Dishonored checks will result in a $35 fee and future payments must be made in cash.

No-Show/Late Arrival

• We schedule by appointment only. 

• Please arrive 15 minutes before your appointment time.

• If you need to change or cancel your appointment, please notify the office 24 hours in advance.

• Failure to notify the office 24 hours in advance, No-show or Late-show (being more than 15 minutes late to your appointment) may result in a $35 fee. 

• More than two missed appointments may lead to dismissal from our practice.

After Hours Calls

• In an emergency, please call 911 or visit the nearest ER.

• After-Hours calls must be for URGENT matters ONLY.

• After-Hours Urgent calls may be attended as Telemedicine visits per clinical discretion

• Non-urgent, After-hours calls (e.g. refills) may be charged $15 per call.  Please call during office hours   

Form Fee & Medical Records

• Forms completed during your annual physical are free.

• Forms requested outside of your visit are $25 each, payable before completion. Please allow 2 business days for processing.

• Medical records requests require a signed "Authorization for Release of Medical Information" form.

• Fees for records are based on pages, retrieval, certification, and postage. Please allow 7-10 days for processing.

• Prior authorization requests are $25 each, payable at the time of request.

Unpaid balances and Credit Card on File Policy

• We securely keep a credit card on file to simplify billing, including for TeleMedicine.

• Any unpaid balance will be charged to your card 5 days after the insurance processing is complete.

• A fee of 2.9% may be added for payments made with a Credit card (Bank charges).  Cash/Zelle payments are Free.

• You can update your payment method at any time.

• Future appointments may be rescheduled or denied for overdue accounts.

• Unpaid balances transferred to collections may result in dismissal from the practice.

By signing below, I agree to the above terms.

Thank you for choosing YouBelong Pediatrics!

We are honored to care for your child and support your family. If you have any questions about these policies, please don't hesitate to ask -- we are here to help.

Signature: ________________________________                   Date: _________________________