Pediatric Center Financial Policy

Pediatric Center Financial Policy

  • Payment is required at the time services are rendered unless other arrangements have been made in advance. This includes applicable coinsurance and co-payments for participating insurance companies. Pediatric Center accepts cash, personal check, Visa and Master Card. There is a service charge for returned checks of $35.00. Patients with an outstanding balance of 90 days overdue must make arrangements of payments prior to scheduling appointments. We realize that people have financial difficulty. Therefore, we may advise that due to your financial situation you seek your child’s immunizations through a clinic or health department.


    We bill participating insurance companies as a courtesy to you. You are expected to pay your deductible and co-payments at the time of service. If we have not received a payment from your insurance company within 45 days of the date of service, you will be expected to pay the balance in full. You are responsible for all charges. We do bill secondary insurance companies as a courtesy to you. It is your responsibility to provide accurate insurance information to us at time of service. If you need assistance or have questions, please contact the Billing department between 8:30am to 5:00pm Monday through Friday at (804) 262-4912.


    If you are enrolled in a managed care insurance plan, (i.e., HMO) you must receive a referral from our office before seeing a specialist. Please call 3 business days in advance, as a courtesy, to allow us time to complete the referral. No retroactive referrals will be given.

    Missed Appointments/ Late Cancellations

    Broken appointments represents a cost to us, to you and other patients who could have been seen in the time set aside for you. Cancellations are requested 24 hours prior to the appointment. We reserve the right to charge a $25.00 fee for missed or late-cancelled appointment. Excessive abuse of scheduled appointments may result in discharge from the practice.

    Pediatric Center whenever necessary. I also agree that if it becomes necessary to forward my account to a collection agency, in addition to the amount owed, I also will be responsible for the fee charged by the collection agency for costs of collections.

    Notice of Privacy Patient Acknowledgement and Authorization

    1. I acknowledge that the Notice of Privacy for Pediatric Center, was made available to me. 2. I consent to the use or disclosure of my protected health information for the purpose of diagnosing or providing treatment to me and obtaining payment for my health care. 3. I may be contacted by telephone at the following numbers. Messages to return to the office call and appointment reminders can be left at these numbers. (Personal health information such as test results CANNOT be left on an answering machine. Personal health information can only be shared with other people authorized by the patient.)