Financial Policy

Financial Policy 

Last Modified: May 9, 2024

Thank you for choosing Hello Pediatrics Medical Group, PLLC (“HP,” “we,” “our” or “us”) for your child’s healthcare needs. We are committed to providing high-quality care and ensuring a seamless experience for you and your child. To facilitate a clear understanding of our financial policies, please review the following information: 

1. Payment Policy: 

• A one-time credit card payment will be taken at the time of service.
• Self-Pay patients must pay in full at the time of service. The charge for a self-pay medical visit is $49.00, and a behavioral health visit is $199.
• A “No Show Fee” of $25.00 or a “Rescheduling Fee” of $25.00 may be applicable for medical appointments missed without 24 hours advance notice. Fees for rescheduled or missed mental health appointments are $65.00. 
• The credit card on file will be charged at the start of your visit. 

2. Authorization for Charges: 

• You authorize Hello Pediatrics Medical Group, PLLC or its billing vendor to charge your credit card. 
• By using a credit card or other accepted payment option with HP (“Payment Option”), you explicitly authorize HP to charge fees for your Service usage and any relevant taxes to the Payment Option. If your health insurance covers the Service, note that we may not have complete information about your insurance such as co-payment, co-insurance and deductible amounts at the time of service. Consequently, we may bill you multiple times for a specific visit to accommodate any additional insurance and any non-covered amounts owed. You acknowledge that Payment Option authorizations remain in effect until canceled in writing, and you commit to keeping us informed of any Payment Option changes. You affirm that you are an authorized Payment Option user and will not dispute charges corresponding to the visit or payment amounts required by your health insurance plan. We may at our discretion, process a visit payment for a period up to one (1) year. You recognize that all payments from your account must adhere to federal, state, and local laws.
• You authorize Hello Pediatrics Medical Group, PLLC or its billing vendor to submit insurance claims for payment. 

3. Billing Procedures: 

• Charges are based on clinical documentation and represented by standard billing codes. 
• If charges exceed today’s payment your credit card will be charged. 
• If you do not have a credit card on file, we may bill you for any co-insurance, co-pay, deductible, or non-covered amounts exceeding the visit amount.  
• Refunds will be issued if an insurance claim results in a credit. 

4. Insurance Coverage: 

• Visit our website or contact us directly for a complete list of accepted insurance plans. 
• Please bring your identification and the patient’s insurance card to each visit. 
• It is your responsibility to verify insurance coverage. 
• You are responsible for in-network payments, including co-pays, co-insurances, deductibles, and non-covered services due at the time of service.  
• You are responsible for the full cost of your visit if you are out-of-network or have no insurance. 
• You understand that you are responsible for charges resulting from non-payment or denial by your insurance. 

5. Insurance Verification: 

• You agree to provide HP with current and accurate insurance information.  
• We will attempt to verify your insurance, and if unsuccessful, you may be financially responsible. 
• You assign your healthcare benefits to Hello Pediatrics Medical Group, PLLC. 

6. Balances/Delinquent Accounts: 

• You acknowledge your financial responsibility for any balance. 
• You agree to pay any balance immediately upon notification. 
• Patient balances older than 90 days may be sent to collections. 
• HP reserves the right to deny non-emergency services if your account is delinquent.

7. Legal Agreements: 

• As the parent or legal guardian requesting or arranging services, you have the legal right to authorize care and treatment for the patient/child. 
• You acknowledge that documentation of legal agreements may be necessary in certain cases. 
• You are the responsible party for payment at the time of service. 

8. Appointment Policy: 

• Please be on time for your scheduled appointment. 

9. Insurance Reimbursement: 

• We cannot guarantee your health plan will pay your claim. 
• In-Network: We bill your insurance directly for services provided. You will be responsible for your deductible, coinsurance, copay and non-covered amounts after receiving your Explanation of Benefits. 
• Out-of-Network: We can help submit a claim for reimbursement, even if we are out-of-network. If we cannot submit a claim, we will provide you with the forms you need to submit it yourself. 
• Important note: Therapy sessions (in-person or online) may be covered differently or not covered at all by your plan. Check your plan to verify coverage. 

10. Billing Inquiries: 

• Contact 703-322-0245 for any questions about insurance/billing. 

11. Good Faith Estimate: 

• You have the right to receive a Good Faith Estimate for health care costs. 
• You can dispute any bill exceeding the estimate by $400 or more. 
• For more information, visit www.cms.gov/nosurprises. 

These policies and fees are subject to change. We will do our best to keep you informed of any modifications. 

Thank you for your cooperation and understanding. We are committed to working with you for your child’s health and well-being.