We are delighted you have selected Eden Park Pediatrics for your child’s medical care. Our mission is to provide high quality, cost-effective care to the children of our community. To do this, we need your full commitment to our financial policy.
It is your responsibility to know your insurance benefits.
Your insurance policy is a contract between you and your insurance company, even if your employer provides it. There are many subtle differences in insurance policies, and employers frequently change coverage and co-payments. You are responsible for knowing what services are covered, how often (example - well visits), and how much of the cost is your responsibility.
You are responsible for:
This is to protect you from receiving a bill because we did not have correct insurance information. We will attempt to validate your insurance benefits at time of service and alert you to any problems. If we cannot validate your coverage, we may assign your account to self-paid status and request full payment at the end of your visit. Secondary insurance is just as important as primary!
You must present your insurance cards at every visit.
Your insurance card has information you want us to have – like where to send claims, lab work, and who we may refer to. Bring your insurance card to every visit. You should also be aware of where your insurance wants you to go for any lab or radiology procedures, so that in an urgent situation, you are seen at the appropriate facility and will not receive a bill.
You must pay your copay at the time of the office visit.
Our contracts with insurance companies require us to collect your copay at the time of service. We accept cash, credit cards, and checks as forms of payment. If you do not pay your copay at time of service, we will assess a missed copay fee of $20.
If your insurance plan requires you to choose a primary care provider, you must contact your carrier and select one of our doctors before your visit.
In accordance with carrier guidelines, we cannot schedule any appointments or write any referrals until we receive notice that you have been added to our roster.
If we are participating providers (in-network) with your insurance plan:
If we are not participating providers (out-of-network) with your plan:
If we are unable to verify your coverage with your insurance plan:
You must contact your insurance carrier immediately after your child’s birth so that your baby is covered under mom’s policy/ID number for the first 30 days.
Permanent coverage must be in place before the 30-day newborn coverage expires.
When your child is seen for preventive care (also known as a well care visit) there may be times when he or she needs an additional service that is not considered preventive. If your child is not well, or a problem is found that needs to be addressed, or you would like to address a problem unrelated to the well visit, the physician will need to provide additional services to care for your child. These additional service are billed to your health plan in addition to the preventive services provided on that day. If you have a copay for office visits, it must be paid at the time of service. Any coinsurances or deductibles must be paid upon receipt of our first billing statement. Some services that may be provided and billed in addition to preventive services include:
$50 Missed Appointment/Late Cancellation Fee – Missed/Late Cancelled appointments represent a cost to us and to other patients who could have been seen in the time set aside for you. If you need to cancel your well/routine appointment, please contact us at least 24 hours in advance. If you need to cancel your sick/urgent appointment, please contact us at least 2 hours in advance. Recognizing that “life happens” we do not assess a fee for the first missed appointment.* However, a $50 fee will be charged for a second missed appointment. A third missed appointment will result in discharge from the practice. *New patients who miss their first appointment will not be rescheduled.
School/Daycare/Boy Scout Forms - A $5 Form Fee will be charged for the completion of school/daycare/Boy Scout forms. Form will be completed and ready for pickup within 7 – 10 business days. The Form Fee is waived if form is presented at well child visit. If form is needed sooner than 7 – 10 business days, a rush fee will be charged.
PIAA Forms - A $15 Form Fee will be charged for the completion of a PIAA form. Form will be completed and ready for pickup within 7 – 10 business days. The Form Fee is waived if form is presented at well child visit. If form is needed sooner than 7 – 10 business days, a rush fee will be charged.
$30 Returned Check Fee - In the event a personal check is returned unpaid from your bank, your account will be charged with a returned check fee of $30, and your account may be placed on a “cash only” basis until the balance and fee are paid.
$20 Rebilling Fee – A rebilling fee will be charged:
$5 Medical Record Summary Transfer/Copy Fee – A $5 fee is charged to transfer/produce a copy of your child’s medical record including immunizations, problem list, diagnosis history and growth charts.
$25 Evening/Saturday/Holiday Convenience Fee – For your convenience, we offer appointments after the standard 9 – 5 weekday. We charge a $25 convenience fee for this service. Both insurance plans and parents realize that this fee is a cost-effective alternative to a visit to the Emergency Room/Urgent Care and/or taking time off work. This fee is added to all sick visits that are provided:
$35 After Hours Fee – If your child needs care when our office is closed, call us. One of our physicians is always on call and will open the office to see your child if it is determined an office visit is advisable. A $35 fee is charged for providing this after hours care.
$100 Reinstatement Fee - Eden Park Pediatrics may, at its discretion, make a one-time exception to reinstate accounts that have been terminated due to missed appointments/delinquent payments.
Thank you for your assistance! We appreciate it!
We are participating providers with the following insurance plans.
Capital Blue Cross
Preferred Health Care (PHC)
Our patient panels for Medical Assistance are at maximum capacity. We cannot take on ANY new Medical Assistance policies at this time.
What does this mean?
NEW PATIENTS: If you have Medicaid (primary or secondary) we are unable to add you to our practice.
ESTABLISHED PATIENTS WITH COMMERCIAL INSURANCE WHO SWITCH TO MEDICAL ASSISTANCE: If you switch from a commercial plan to Medicaid, that is a new policy. Therefore, we will not be able to continue to see you. We will help you transition to a practice that is accepting patients with Medicaid.
ESTABLISHED PATIENTS WITH MEDICAL ASSISTANCE: If you are an established patient and on our UPMC For You panel, we can continue to see you.