Scheduling and Billing

Appointment, Billing, and Medical Record Information

At Macomb Pediatrics in Warren and Clinton Township, Michigan, we want you to know what to expect during your doctor’s visit. We invite you to read through our appointment policy and billing practices. Please be sure that you bring your picture I.D. and insurance card with you to our office.

Financial

A summary of the financial policy is provided below:
MPA will bill the insurance company listed for all patient visits on the patient’s behalf. Ultimately, the patient/parent/guarantor is responsible for all balances that the patient’s insurance is not contractually obligated to pay. All patients should know their own insurance policy and what the policy may or may not cover, including routine labs and screening coverage.

It is not the office’s responsibility to supply coverage and benefit information to the patient. It is also the patient/parent’s responsibility as a guarantor to have all the insurance and personal information in the patient’s chart to be correct and up to date at every date of service, including but not limited to phone numbers, home address, email address, etc.

Account Statements and Balances

If left unpaid, balances will be addressed at every appointment to be collected in full. Account statements detailing account balances will be generated and mailed home to the address listed on the account. After three generated statements and no payment has been made towards the balance, the account will then be sent for review for collections.

Patients without Insurance Coverage

We understand that sometimes patients lack insurance coverage. For these situations, we have a self-pay/time-of-service fee schedule. These fees are only applied to patients who are truly without insurance, and all balances must be paid in full prior to the services being performed. For more information, please call our Billing Department at (586) 573-9231.

Co-Pays and Account Balances

All copays are due before being seen for any patient appointment. We accept all forms of payment, including cash, credit card, or check. We do expect that if there is an outstanding account balance that the guarantor will voluntarily pay all balances due from past services as well as current copays before the next service is rendered.

Appointment Fees – Late/Same-Day Cancels/No Shows

Parents/guardians are responsible for making sure patients arrive on time for their appointment. MPA will make reminders phone calls to confirm the appointment. Any appointment made within two business days is considered to be an automatically confirmed appointment. In order to be on time, you should arrive at the scheduled appointment time. Parents/guardians are asked to give a 24-hour notice prior to any appointment cancellation or rescheduling.

Late Fees

If a patient is more than 15 minutes late, MPA reserves the right to cancel the appointment if determined based on the clinician’s schedule, and a late cancellation/reschedule fee of $25.00 will be applied.

Same-Day/No-Show Fees

No show/no call is defined as no notice within 1 hour of the scheduled appointment time, which is subject to a $25.00 fee. No-show appointment is subject to a $50.00 fee. After two missed no-call/no-show appointments, a letter will be mailed home as a warning reminder of our office appointment policy. After three missed no-call/no-show appointments, a dismissal from the practice letter will be mailed home, and MPA will provide 30 days of temporary care until a new primary care physician is established.

Insurance

Macomb Pediatric Associates, P.C. participates with many insurance plans. It is the patient’s responsibility to provide the most current insurance and know their insurance policy before services are rendered in our office.

If you have a new insurance plan and do not have your card at the time of visit, we will not be able to bill the insurance carrier. Payment will be required at the time of service. If we receive your insurance card within the filing limits of your insurance, we will submit the claim to the insurance carrier for possible reimbursement. If a service is rendered and believed to be covered, our billing department will submit the service to the appropriate insurance plan.

Co-payments are due at the time of service. You are responsible for any co-insurance, deductibles, and/or non-covered services not paid for by your insurance. Payment will be required upon receipt of the statement. Accounts that do not reflect payment for a prior balance after three statements will be sent to an outside collection agency. At that time, the account will be turned over to collection, and the doctor/ patient relationship will be terminated.

Please call the office to confirm updated insurance participation.

All HMO and Medicaid policies will require a (PCP) Primary Care Physician from our practice to be assigned to the insurance policy.

*Note: If the correct PCP assignment is not selected and backdated to the date of birth/start of the policy, patients are responsible for all financial charges.

We accept a wide range of PPO, HMO, and Medicaid insurance plans, which include but are not limited to:

Private Insurances:

Blue Cross Blue Shield of Michigan
Blue Care Network
Health Alliance Plan
Aetna
Smart Health
Cigna
Priority Health
Smart Health
UnitedHealthcare
UMR

Medicaid Policies:

Meridian
McLaren
UnitedHealthcare
Priority Health
Blue Cross Complete

If your insurance policy is not listed, please call our billing department.

18+/College Transition to Adult/Family Medicine Policy

Patients 18 years and older, according to the patient’s insurance policies, will be transitioned to adult/ family medicine practice to further provide age-appropriate medical care. In some instances, patients 18 and older can remain with MPA under the agreement that an up to date yearly physical be completed on file by Macomb Pediatric Associates, P.C. If that agreement cannot be withheld, they will no longer be able to be seen for sickness or annual appointments and will be dismissed to adult medicine.

Specialist Referral Policy

HMO insurance policies might require an insurance referral to be seen by a specialist provider. It is the patient’s responsibility to contact MPA and provide the necessary information to process a referral request. Please ensure an adequate time frame is given to complete the request. Same-day requests may not be able to be completed.

Prescription/ Medication Contract Policy

MPA will not prescribe any medications without seeing the patient. Our policy states that patients receiving prescriptions for controlled substances are required to sign a Controlled Substance Agreement and adhere to protocol. After the initiation of treatment, a follow-up visit is required within 30 days, and then every 3 months after that. If there is a change in dosage needed, then you will be asked to come back within 30 days. There are no exceptions to this rule. No refill of controlled substance medication prescribed can be made if these follow-up visits are not kept. For any medication refill, parents/guardians/patients must call the office three days before the refill expires to request a refill if the patient is up to date with the necessary visits.

Respect/Right to Reserve Privacy Policy

As permitted by law, MPA reserves the right to amend or modify our practice policies. We will adhere to all HIPAA guidelines to maintain the privacy of your protected health information. All patients, regardless of race, color, sex, or gender identification, will be respected and provided appropriate care. MPA carries a ZERO TOLERANCE policy for any verbal abuse to/from our patients, staff, and providers. Any abuse of relationships will result in an automatic dismissal.

Appointment Late Arrivals/Cancellations/No Shows

Macomb Pediatrics provides courtesy reminders ahead of a scheduled appointment. We do our best to do the courtesy reminders, but it is the parents/guardians/patients’ responsibility to keep track of their child’s appointments.

Arrivals past the scheduled appointment time may need to be rescheduled. We do not guarantee a ‘grace period’ and cannot honor all late appointments.

All appointments must be canceled 24 hours prior to the scheduled appointment time or are subject to a cancellation fee of $25 per child. No-show appointments are a disservice to the practice and patients. All no-show appointments will be charged a $50 fee per child. If multiple no-show appointments occur, the entire family will be dismissed from the practice with written notice.

Divorced/Separated/Custody Family Policy

Macomb Pediatric Associates, P.C. cannot and will not become involved in legal issues such as divorce, separation, or custody issues unless requested through appropriate legal means. MPA kindly requests that any medical decision-making, including but not limited to vaccines, medication, etc., be agreed upon prior to the appointment.

Payments (including copays, deductibles, and balances) are due at the time of the service of the appointment, regardless of which parent is responsible for coverage. All payments due will be collected. MPA is not responsible for enforcing any legal financial agreements between the parents.

Neither of the patient’s parents will be limited to accessing their child’s medical information or appointment scheduling unless the court orders with proof of the order in the medical record.

MPA will not call the opposite parent to inform them of appointment scheduling, cancellation, or requests. In addition, we will not call the parent who was not present at the appointment to discuss the appointment’s events. All updated legal documentation pertinent to the patient’s medical decision-making must be provided to MPA in an appropriate and timely manner to keep in the medical record.

MPA will not tolerate abusive appointment cancellation and rescheduling patterns between parents.

Verbal abuse of staff members will not be tolerated.

*If any issues arise that become disruptive to our practice or impact the care of the patient, MPA reserves the right to discharge the entire family from treatment at Macomb Pediatric Associates P.C. No exceptions or accommodations will be made.