Financial Policy

Financial Policy

Last Modified: January 30, 2025

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 $49 deposit is required from all patients prior to the provision of services (see Medicaid section for exceptions).
   • For patients with active insurance coverage, the deposit will be applied toward the patient’s financial responsibility, including but not limited to copayments, coinsurance, deductibles, or charges for services determined to be non-covered or out of network by the patient’s insurance plan.
   • Insurance coverage for telehealth services varies by payer and plan and is not guaranteed. The practice will submit claims to the patient’s insurance carrier when applicable; however, patients remain fully responsible for any balance not paid by insurance.
   • Medicaid Notice: Patients enrolled in Medicaid or a Medicaid managed care organization (“MCO”) are subject to additional requirements. If the practice participates with the patient’s Medicaid MCO, the patient will not be charged the $49 deposit, and services will be billed in accordance with applicable Medicaid and MCO rules. If the practice does not participate with the patient’s Medicaid MCO, services may be provided only after the patient executes a separate Medicaid financial responsibility waiver, as required by law. In such cases, the $49 deposit will be applied in accordance with the terms of the executed waiver, and patients acknowledge that such services may not be billable to Medicaid or eligible for reimbursement. Patient and/or guardian acknowledges that they are aware that they are not required to receive care from this practice and have the option to seek care from a Medicaid-enrolled provider or a provider who will request any necessary prior authorization.  Patient and/or guardian is choosing voluntarily to receive services from this practice and choosing voluntarily to pay the $49.00 and have full understanding of alternatives.

1. 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 as needed 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.

1. 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 will bill you for any co-insurance, co-pay, deductible, or non-covered amounts exceeding the visit amount.

1. • Refunds will be issued if an insurance claim results in a credit.

1. Insurance Coverage:
   • Visit our website or contact us directly for a complete list of accepted insurance plans.
   • Please provide your identification and the patient's insurance card at each visit.

• It is your responsibility to verify insurance coverage.

1. • 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 for $49.00 if you have no insurance.
   • You understand that you are responsible for charges resulting from non-payment or denial by your insurance.

1. 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:

1. • 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.

1. 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.

1. Appointment Policy:
   • Please be on time for your scheduled appointment.

1. Insurance Reimbursement:

• We cannot guarantee your health plan will pay your claim.
• 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.

1. Billing Inquiries:
   • Contact 703-322-0245 or billing@hellopediatrics.com for any questions about insurance/billing.

1. 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.