Get Billing Policy Of Clarkstown Pediatrics

Filling out the billing policy of Clarkstown Pediatrics is an essential process for ensuring that your child receives the necessary medical care while understanding your financial responsibilities. This guide provides clear, detailed steps to help you navigate the billing policy form with ease.

Follow the steps to complete the billing policy form thoroughly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Review the section regarding financial responsibility. Guarantors or legal guardians are required to sign a financial waiver, indicating their acceptance of responsibility for payment of services provided during the visit.
3. Confirm the details regarding preventive care appointments. Ensure you understand the guarantor’s duty to verify insurance benefits prior to the visit. Fill in the required information as needed.
4. Complete the copay section by noting that copayments are due at the time of service. Ensure you acknowledge any charges for missed copays as outlined in the policy.
5. Provide any additional service information that may arise during preventive care appointments. Acknowledge that certain concerns may require further evaluation and may incur additional charges.
6. Indicate your preferred payment method. Review the accepted payment types and be aware of the additional service fee for any returned checks.
7. If applicable, ensure to acknowledge the 'self-pay patient' process and the minimum deposit required if there is no insurance coverage.
8. Understand and fill out the payment arrangements. Note that balances are due within 30 days, and if you require assistance, it is important to contact the Patient Account office.
9. Verify that you have provided accurate healthcare insurance information. This is crucial to avoid being classified as a self-pay patient.
10. Finally, review the policy understanding clause, sign and date the form, printed name and children’s information needs to be filled out completely before saving your changes.

Complete your billing policy form online today to ensure a smooth process for your child’s medical care.