FINANCIAL PAYMENT POLICY FOR BROAD RIPPLE PEDIATRICS
INSURANCE: The office participates in many insurance plans. We will bill your insurance according to the contract guidelines. A current copy of your insurance card must be on file to submit a claim. If the correct information is not given to Broad Ripple Pediatrics and your claim is denied you will be responsible for payment in full. A $25 fee may be assessed to refile with correct insurance. Information submitted to office past the timely filing date will be your full responsibility.
BALANCE DUE: That amount due the office within 30 days after insurance company has paid their portion. If unable to pay in full it is necessary to call the office and make payment arrangements. Your account may be assessed $20/month for every month we send a statement 30 days after insurance has paid. After 60 days, account is at risk to be sent to collections.
COLLECTIONS: If account goes to collections, your child will be seen for 30 days, urgent care only. It will be necessary to find a new physician for your family. For collection services, a $25 fee is assessed an any additional costs per court judgment.
ADDITIONAL FEES:
Missed sick appointments (if not cancelled 2 hours prior):$20
Missed routine well appointment (if not cancelled 24 hours prior): $30
Returned check: $35
Co-payment not paid at time of service: $20
School/sports/daycare/camp forms (waived if presented at time of well visit): $10
“Rush” (same day) school/camp form (waived if presented at time of well visit): $30
Transfer records out: $15/patient, $30 max/family
FINANCIAL HARDSHIPS: Parents may set up payment plans when unable to comply with financial policies. If special arrangements are necessary please advise our staff prior to visit.