Our policies
Affordable Care Act Information
The Affordable Care Act is intended to provide everyone access to affordable, high-quality health care — and that’s a goal we strive for every day.
What do parents need to know and how can you make this work for your family? That can get a little complicated, depending on your situation. But to start, here is what you need to know:
- Everyone must have health insurance or face tax penalties and/or other consequences.
- If you already have insurance through your employer, that can remain in place or your employer may choose to have employees use asn online insurance marketplace for their health insurance.
- If you don’t already have insurance, you can shop for coverage on the online insurance marketplaces (also called insurance exchanges) for each state. Plans are intended to be affordable compared to typical health plans and there are subsidies available to help low- and moderate-income families.
- You can no longer be denied coverage for pre-existing conditions, nor can insurers cancel your coverage if you get sick.
- PAK is a proudly independent, physician-owned practice. We accept most insurance plans, so your ability to choose us should not be affected by the marketplaces or other insurances.
Important Items for Children & Young Adults - All plans must include coverage for basic well-child care, including immunizations, vision, dental.
- Most young adults can remain on their parents’ health insurance until they turn 26 years of age.
- most young adults who age out of foster care at 18 years or older are eligible to receive coverage through Medicaid until they turn 26 years old. Those adopted from foster care may qualify for Medicaid coverage until age 26, depending upon income.
Balances & Deductibles
We’re responsible, as detailed by the terms of our contracts with health insurance companies, for billing you for any portion of your treatment that your health insurance carrier does not pay and assigns as your responsibility. You are responsible for paying this portion of your bill.
Co-Payments
Financial Policy
Upon initial registration we require the following information and items: Insurance Card, full name, date of birth, employer and address of the plan member; the patient’s address, date of birth, and contact phone numbers and email addresses for both parents and/or all guardians.
Our full Financial Policy is available for your review under Common Forms.
Infomation Sharing - Cures Act
The goal of the practice is to make every effort to share information with patients and authorized representatives in order to empower them to be active participants in their care. Sharing of information will be accomplished through both active (upon request) and passive (information that is made available without explicit request) methods as outlined in our Information Sharing Policy.
For a downloadable copy of our Information Sharing Policy, click here. Check your download folder after clicking.
Guarantor-Parent/Guardian
The parent or guardian who signs the patient’s paperwork is the party responsible for all charges and payments. Due to confidentiality laws, we can only bill the person who signs the practice paperwork. Therefore, if the person responsible for the medical bill changes, the new guarantor must fill out a new set of paperwork. If your payment circumstances change, please inform us right away. We do have packets for patients 18 years or older that must be completed. These forms explain to the patient their responsibility with their account now that they are a young adult.
Health Insurance Cards
When scheduling each appointment, our team will verify your insurance information. Our office staff will verify your eligibility prior to or at check-in for each appointment. If your insurance information changes, please notify us as soon as possible. Please make sure you bring your card to every appointment.
Health Insurance Plans
Because we participate with many different plans, we can’t know the provisions of each patient’s policy. We do recommend that you make every effort to understand your insurance coverage and, if necessary, to contact your carrier before receiving services, so you can verify your coverage levels (such as those for preventive care), co-pay, deductible, and co-insurance responsibilities.
Intent to Immunize
It is the policy of PAK Pediatrics that all children who come to our practice for care receive all immunizations that are required to be given according to the schedule put forth by the American Academy of Pediatrics. (Flu and COVID vaccines are not required.)
We are unable to provide care to families who do not follow the required schedule. We will be happy to answer any questions you may have, however, there are no exceptions to this policy without valid medical contraindication.
PAK Pediatrics believes that immunizations are of vital importance in the health of children individually and the population as a whole.
Forms Completion Fee
The cost of researching, filling out, and signing forms is not covered by health insurance programs. We charge a nominal fee to cover the costs and ask for 3-5 business day turnaround for completing these forms.
Newborn Insurance Reminder
Congratulations on the wonderful new addition to your family!
New parents don’t always know, or they may forget during the busy, crazy, wonderful days that follow the birth of a child, that babies are not automatically covered on all insurance plans. So here’s some important information you’ll need to remember:
- Not all insurance policies offer automatic coverage for new babies.
- Some plans do offer 30- or 31-day coverage until you can physically add the baby to your plan.
Late Fees / Collections
If you don’t make full payment (or call to set up a payment plan) within a reasonable time period, you will be charged a $5 billing fee each billing cycle to cover the cost of sending you a bill.If your account maintains an open balance, it may be sent to collections and subject to an additional 25% collection fee. If you’re having difficulty meeting medical bills, please let us know. We’ll be happy to help you by setting up a payment plan.
We encourage our patients to take advantage of this option, as we may have to dismiss from our practice patients who fail to meet their financial obligations.
Making Sure Your Baby is Covered
We recommend that you check with your HR department or member services to see how your individual health plan works, and to begin the process of adding your baby to the insurance.
If the newborn coverage period has ended, and the newborn is not showing active on an insurance policy, the baby’s parents will be responsible to pay out of pocket for the visit. This may also lead to a lapse in coverage for your child.
If your child has been added to an HMO, CHIP, or Medical Assistance plan, it’s imperative that you have PAK listed as the PCP.
If you have any questions or concerns, just give us a call at: 570-288-6543, option 6.
Missed Appointments
To give us time to check you in, confirm demographic info, verify insurance, and collect co-pays and balances, we ask that you arrive ten minutes before your scheduled appointment time.
We understand, of course, that sometimes things happen that may prevent you from arriving that early. Or even on-time. We’re happy to be flexible, but we also need to keep other patients and their appointments running on schedule. So if you arrive more than fifteen minutes after your scheduled appointment time, you may need to reschedule.
We also understand that sometimes life happens, and you just can’t make your appointment. When that happens, please call us at least one full business day in advance to reschedule or cancel your appointment.
If you don’t call to cancel in advance, you’ll be charged a No-Show Fee ($25 for most visits, $50 for Same Day Sick, $75 for Behavioral Health) to cover the cost of the unfilled appointment.
Multiple late or missed appointments may result in dismissal from the practice.
Returned Checks
If you pay by check and your check is returned for insufficient funds (NSF), you’ll be responsible for the amount of the check, plus a returned check fee of $25. If more than one check is returned in any given period, we reserve the right to require all future payment by cash or credit card to prevent those situations from recurring.
Self-Pay Patients
If you don’t have health insurance, we’re out-of-network for your particular insurer, or you’re receiving a non-covered service, payment at the time of the visit is required.. We’re also happy to work with families to create a payment plan for any non-covered services. Just ask us!
For a downloadable copy of the Financial Policy, click here.
Other Resources
The American Academy of Pediatrics (AAP) has developed some great resources to explain this information in more detail, and to help you to access Pennsylvania’s online registry.
Check them out here:
- AAP Pamphlet: The Affordable Care Act and You
- AAP Healthy Children Resource Page: What Your Family Needs to Know (w/ Links)
As always, if you have any questions or concerns, just give us a call in the office. We’re always happy to help in any way we can!