FINANCIAL POLICY

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 commitment to our full financial policy.

 

Financial Responsibilities:

Eden Park Pediatrics will verify that your insurance on record is active, however, it is the guarantor's responsibility to contact the insurance company to confirm what benefits are covered.

 

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 for some plans can be scheduled once per calendar year while other plans can only be scheduled a full 365 days from the previous well visit for children over 3yrs old). Some expenses that may be associated with your child’s visit are:

  • Your copay

  • Your coinsurance

  • Your deductible

  • Any services that your insurance doesn’t cover

 
You must present your insurance cards at every visit:
  • You must provide current, complete, and accurate insurance information at every visit. 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-pay status and request full payment at the end of your visit. 

  • Secondary insurance is just as important as primary!
 

Your insurance card has information you want us to have – like where to send claims, lab work, and who we may refer to. 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 you have a Credit Card on File and you accidentally miss your co-pay in the office, we will waive the $20 missed copay fee and charge the card on file. 

 

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.

  • If you do not select one of our physicians, your insurance company will deny claims submitted for that date of service. 

  • In accordance with insurance guidelines, we cannot schedule any appointments or write any referrals until we receive notice that you have been added to our roster.

Insurance

If we are participating providers (in-network) with your insurance plan:
  • We participate with many major insurance companies. Before scheduling an appointment, please confirm that we are participating providers with yours.

  • If there is a balance remaining on your account, payment is due at time of service. This balance may be from your coinsurance, your deductible, or any services your insurance did not cover.

  • If we are participating providers with your insurance plan, all services performed in our office and at the hospital will be submitted to your insurance plan as a courtesy to you.

  • If there are any problems with this submission, we will notify you and request your prompt assistance with any conditions under your control that are causing a delay in processing (eg. coordination of benefits, wrong insurance ID number, newborn not added to policy). If your insurance carrier does not respond within 30 days, we will contact your insurance for a status update. If your insurance carrier does not respond to our status update request within 60 days from the original date of service, we will send you a statement, and payment will become your responsibility. You will need to contact your insurance carrier if you think they are responsible for payment. Payment from you or them is due within 30 days.

Coordination of Benefits (COB):
  • What is Coordination of Benefits? You must provide your insurance company with the most up to date information each year. If your child is covered by more than one plan, those plans need to work together to make sure your visits are paid correctly. One plan becomes your primary plan. It pays your claims first. Then the second plan may pay toward the remaining cost. 

  • How is primary and secondary coverage determined? The “Birthday Rule” determines when a plan is primary or secondary for a dependent child when covered by both parents' benefit plan. The parent whose birthday (month and day only) falls first in a calendar year is the parent with the primary coverage for the dependent.
  • Your child’s insurance plan may reject the claim(s) because they need up-to-date information to verify a potential secondary insurance. When this occurs you will have a balance on your account until you call your insurance company(ies) to resolve it and we will be unable to see your child for well checks and vaccinations. We are unable to call your insurance company, only the subscriber can call to verify it. We must have up to date insurance(s) for each visit.
If we are not participating providers (out-of-network) with your plan:
  • If we do not participate with your insurance plan, payment in full is due at time of service. No exceptions – please do not ask us to bill you.

  • We will provide you with an itemized bill so you can submit the charges to your insurance for reimbursement.

If we are unable to verify your coverage with your insurance plan:

  • If we are unable to verify your insurance coverage, all services must be paid for at the time of your visit.

    • Upon receiving verification of coverage, we will bill your insurance company and refund any amounts owed you after your plan has processed the claim.

If you do not have any insurance coverage:

  • If you do not have any insurance, payment is due at time of service.

  • We provide a courtesy discount of 20% on all services rendered when payment is made at time of service, excluding immunizations.

  • Immunizations will be provided via the Vaccines for Children program. The allowable rate for administering VFC vaccines (set by the VFC program) will be charged for each vaccine administered.

 

Newborns

If you have a newborn or newly adopted child, congratulations!

  • 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.

    • Be sure to check with us to confirm we are participating providers with mom’s insurance plan.
      We give step-by-step instructions on how to add your newborn under our "How To..." tab right here on our website!

  • Permanent coverage must be in place before the 30-day newborn coverage expires.

    • Your child must have his/her own insurance coverage by the one month well-visit and should have an insurance card to present at that visit. If you have not received an insurance card, contact your insurance company prior to the visit to verify coverage and get an active insurance ID number. If you do not have active coverage your 1 month visit you will be responsible for the bill.

    • The estimated price of the one month visit will vary based on insurance but will range from $250-$300.

Well Visits

Regular well-child care is one of the most important steps you can take toward protecting your child from serious illness. Preventive care promotes healthy growth and development. Well-child visits also provide you with the opportunity to discuss any questions or concerns you may have about your child’s health.

 

Most health plans cover a set of preventive services for children without charging you a copayment or coinsurance. This set typically includes the cost of the well child visit, most immunizations, and many preventive screenings. We follow the guidelines provided by the American Academy of Pediatrics and Bright Futures (https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf). While most plans cover most services, some plans do not cover some services. You are responsible for understanding your health plan’s coverage and for payment of any non-covered service. A complete list of services provided at each well child check can be found at www.edenparkpeds.com/wellexams

 
Well Visits with Additional Services

When your child is seen for a well- child visit there could be a reason(s) for additional services; these services may not be considered preventive. If a concern 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 services are billed to your health plan in conjunction with the preventive services provided on that day. Some services that may be provided and billed in addition to preventive services include:

 
  • The doctor’s work to address more than a minor problem, which will be billed as an office visit (e.g.,  if the doctor gives a prescription, orders tests, or changes care for a known problem)

  • Medical treatments (e.g., breathing treatments or wart treatments)

  • Any surgery (e.g., removing splinters or something the child put in his ear or nose)

  • Tests performed in the office that are not included in the Bright Futures plan

 

Our physicians are required to report all services rendered to your health plan based on federal guidelines and the actual services provided. Please feel free to ask questions about services that may not be covered as preventative by your health plan on the day of your visit.

 

Divorce, Custody and Payment

  • In the case of divorce: for anything other than 50/50 custody, we must have a court-ordered custody document on file scanned into your child’s chart. You can physically bring the hard copy documents into the office or you can have them faxed to us. 

    • If there is not a custody document scanned into your child’s chart, both biological parents are allowed access to their child’s medical records and both parents are allowed to bring their child to their well appointment. 

    • You may also present a temporary custody document for us to file while you are awaiting the official documents. 

  • The adult who accompanies a child to an appointment is responsible for full payment of copays and non-covered services for that day.

  • Subsequently, bills will be sent to the address of record and the parent who lives at that address will be responsible for payment.
     

Eden Park's EasyPay

Our goal is to improve the patient's experience to find even better ways to serve our families. Eden Park's EasyPay does both. By automatically processing payments and co-pays, it makes your visits faster and your payments much easier, saving your time and mail and paperwork.

We will have you sign our Eden Park's EasyPay Authorization form authorizing:

  • Eden Park Pediatrics to charge your unpaid co-payment and/or 60-day + overdue balances under $200 to your chosen credit card. We will send an emailed receipt for any charge.

  • Eden Park will contact you to discuss payment options for any balances over $200. 

  • If payment collection is attempted and there are insufficient funds, our billing specialist will reach out to you to discuss payment options. 

  • The authorization will remain in force on each of your children’s accounts until they are no longer patients of Eden Park Pediatric Associates or until a written request by the cardholder instructing the practice to remove the authorization is received.

Benefits to using Eden Park's EasyPay:
  • EasyPay makes your appointments a breeze! If you use EasyPay you can simply ask staff at check-in/check-out to charge the card with EasyPay for co-pays or balances on your account.

  • If you accidentally miss your co-pay after you leave your appointment, we can charge EasyPay and will waive the $20 missed co-payment fee. 

  • If you have a balance of under $200 and it is over 60 days past due, we can charge the EasyPay and you will not be charged any additional fees. 
     

Personal Balances

Personal balances are due upon receipt of the initial bill.

Any unpaid personal balance overdue by 30 days:
  • Eden Park will call or text regarding the balance and a letter with a bill will be sent in the mail. 

Any unpaid personal balance overdue by 60 days: 
  • Eden Park will call or text

  • A letter will be sent in the mail and a $20 rebilling fee will be applied to the balance

  • If you have a credit card on file and your personal balance is under $200, your balance will be charged to the credit card and you will not accrue the $20 60-day rebilling fee and you will be notified by text. 

    • If your card on file is charged and you have insufficient funds to cover the balance, the $20 rebilling fee will be applied and your balance will continue to age. 

Any unpaid personal balance overdue by 90 days:
  • An additional $20 rebilling fee will be charged

  • A letter will be sent certified mail with a $10 certified mail fee

Any unpaid personal balance overdue by 120 days:
  • A letter will be sent certified mail with a $10 certified mail fee

  • Balances not paid in full within 10 days of the date on the final request letter will be forwarded to a collection agency.  A 33% collection transfer charge will be added to the balance to cover the fee charged to Eden Park by the collection agency. 

  • Your family will be dismissed from our practice. We will provide urgent care only for your children for 30 days and upon request, we will provide you with resources to find a new physician.

 

Service Fees

  • $50 Missed Appointment/Late Cancellation Fee – ‚Äč

    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

  • Form Fees -

    School/sports/daycare/camp forms will be completed free of charge at the time of a well visit. Please complete all of the parental sections of forms prior to presenting to our staff.

    •  School/Daycare/Boy Scout Forms - $5 for standard processing (7 – 10 business days).

    • PIAA Forms - $15 for standard processing (7 – 10 business days)

    • For all forms, add $5 for expedited processing (2 – 6 business days), add $10 for rush (next day)

  • $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:

    • if you do not pay your copay at time of service (unless you have a credit card on file)

    • To balances not paid in 60 days

    • To balances not paid in 90 days

  • $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.

  • $35 After Hours Fee Evening/Saturday/Holiday (Office open) –

    For your convenience, we offer appointments after the standard 9 – 5 weekday. We charge a $25 after hours 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/school. This fee is added to all visits that are provided:

    • After 5:00 pm on weekdays

    • On Saturdays

    • On Federal Holidays (MLK Day, President’s Day, Columbus Day, etc)

  • $35 After Hours Fee (Office closed)–

    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.

 

 

Call: 717-569-8518
Fax: 717-569-3903

Lancaster Office
1725A Oregon Pike
Lancaster, PA 17601

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Brownstown Office
4221 Oregon Pike
Ephrata, PA 17522

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Mount Joy
779 East Main Street
Mount Joy, PA 17552

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