Office Policies

No matter how you feel about the Affordable Care Act, the overall goal of the program is to provide access to affordable, high-quality health care -- and that's a goal we strive for at Hollister Pediatrics every single 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, you need to know…

A FEW BASIC DETAILS

• You must have health insurance, or face tax penalties.
• If you already have insurance through your employer, that can stay the same, or your employer may choose to have employees use the online insurance marketplaces.
• If you don't already have insurance, you can shop for coverage on the new online insurance marketplaces (also called insurance exchanges) for each state. Plans are surprisingly affordable compared to what we're used to, 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.
• Hollister Pediatrics accepts all major and most minor insurance plans. You should always know your coverage prior to scheduling with us, so we recommend you call to make sure we're in-network with your ACA insurance provider.

IMPORTANT ITEMS FOR CHILDREN & YOUNG ADULTS

• All plans must include coverage for basic well-child care, including immunizations, vision, and dental care.
• Young adults can remain on their parents' health insurance until they turn 26 years old.
• Young adults who aged out of foster care at 18 years or older are eligible to receive coverage through Medicaid until they turn 26 years old. People adopted from foster care may qualify for Medicaid coverage until age 26, depending upon income.

For Registration We'll need the following items and information:

• Insurance card
• Name, date of birth, and address of the plan member
• Patient's address and date of birth
• Contact phone numbers for all parents and/or guardians

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 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, contact your carrier before receiving services to verify your coverage levels (such as those for preventive care), co-pay, deductible, and co-insurance responsibilities. You are responsible for payment for any services not covered by your insurance.

Co-Payments

We're contractually obliged to collect, and you're responsible to pay, your co-payment at the time of your visit. Please have your co-payment ready at check-in. If you don't pay your co-payment at the time of service, we'll need to add a fee (currently $10) for the cost of billing you.

Missed Appointments

Life happens, so we understand that sometimes you can't make your appointment. Please call us at least one full business day in advance to cancel or change an appointment. If you don't call to cancel in advance, we reserve the right to charge a No-Show Fee (currently $50) to cover the cost of the unfilled appointment slot. Multiple missed appointments, or failure to comply with other Hollister Pediatrics policies, may result in dismissal from the practice.

Balances & Deductibles

We're responsible, by the terms of our contracts with health insurance companies, for billing you for any portion of assessment and treatment that your health insurance carrier does not pay and assigns as your responsibility. You are responsible for paying this portion of your bill.

Late Fees/Collections

Balances are due upon receipt. If you don't make full payment (or call to set up a payment plan) by the time a second statement is generated, you will be charged a late fee. If your account maintains an open balance, it will be sent to collections. 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.

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 $35. If more than one check is returned in any given period, we reserve the right to require all future payments by cash or credit card to prevent those situations from recurring.

Forms

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 of completing these forms. The fees and processes are posted on our website and may change from time to time.

Guarantor

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 guarantor.

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. For out-of-network plans, we're happy to submit a claim to your carrier on your behalf. We're also happy to work with families to create a payment plan for any non-covered services. Just ask us!

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 that sometimes things happen that may prevent you from arriving 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. If you arrive more than ten minutes after your scheduled appointment time, you'll 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 cancel or change your appointment. If you don't call to cancel in advance, you'll be charged a No-Show Fee (first time free, 2nd time $50) to cover the cost of the unfilled appointment slot.

Multiple late or missed appointments may result in dismissal from the practice.

Congratulations on the wonderful new addition to your family!

New parents often don't realize, or may forget during the busy, wonderful days that follow the birth of a child, that babies are not automatically covered on all insurance plans. Here's some important information you'll need to remember: Not all insurance policies offer automatic coverage for newborns. However, some plans provide 30- or 31-day coverage until you can officially add the baby to your plan. We recommend 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 your insurance.

If the newborn coverage period has ended, and the newborn is not showing active on an insurance policy, you will be responsible to pay out-of-pocket for your visit. This may also lead to a lapse in coverage for your child. If your child has been added to an HMO, Valley Health Plan, or Central Coast Alliance for Health/Medi-Cal it's imperative that you have Hollister Pediatrics or Dr. Hue Nguyen-Ngo listed as the PCP. If you have any questions or concerns, just give us a call.

Individuals at Hollister Pediatrics will not be discriminated against because of race, color, creed, religion, sex, age, sexual preference, national origin, citizenship, marital status, disability, veteran status, or any other status or characteristic protected under federal, state, or local laws.

Acts of discrimination and/or harassment based on any of these factors are inconsistent with our philosophy and core principles and will not be tolerated.

During Well Visits, we perform routine health screenings recommended by the American Academy of Pediatrics and Bright Futures Guidelines. These screenings are considered standard of care; failing to provide them would be to practice substandard medical care.

Insurance companies are supposed to cover these screenings. Unfortunately, not all of them do. Most plans cover screenings at no cost to you. Some recommend the screenings but then count them toward your deductible or co-insurance. Some plans don't cover these screenings at all.

If your insurance company doesn't cover a standard screening, we suggest you call them, ask them why, and strongly urge them to start covering these standard services that benefit and safeguard your child's health. During your child's visits, we may have to perform procedures or provide additional services to provide proper care. Insurance companies require us to bill these services and procedures separately, as additions to the "regular" office visit. As with screenings, most insurance companies cover these procedures and services most of the time. However, some pass the costs to your deductible or co-insurance, and some don't cover them at all.

It's Hollister Pediatrics' policy to provide the best possible care for your child, no matter what insurance you have. We want to provide exceptional health care for your child, not pick and choose when we will and won't provide care based on an insurance company's policies. Because we accept thousands of different insurance plans, we can't know or keep track of what every plan covers.

It's your responsibility to understand what services are covered by your insurance plan.

A SAMPLE OF SERVICES PERFORMED AT WELL VISITS

A SAMPLE OF SOME ADDITIONAL SERVICES AND PROCEDURES THAT MAY BE BILLED WITH YOUR VISIT

If there's a standard screening, service, or procedure you don't want, let us know.

Please understand that if you decline preventive screenings or treatments, you risk missing a preventable disease or delaying treatment for a particular disease or condition for your child.

At Hollister Pediatrics, we believe divorce, separation, and custody agreements should not interfere with a child's medical care.

Responsibility For Payment:

• A parent requesting medical treatment is individually responsible for the payment of that visit's medical bills.
• Hollister Pediatrics is not a party to your divorce agreement; we will collect co-pays and deductibles from the attending parent and will hold the attending parent responsible for any other payments associated with that visit.

Access To Medical Records:

• "Joint Custody" means that each parent has equal access to the child's medical record. Without a court order, we cannot restrict either parent from access to their child's medical information.
• We will not call the other parent for consent prior to treatment or to inform the non-present parent of the assessment and/or plan of care.
• We will discuss information pertinent to the child's history and exam with the accompanying parent at the time of the visit. It is the parents' responsibility to communicate with each other.
• For this reason, we recommend that both parents have their own Patient Portal account, so each has access to their child's medical records at all times.

Compliance With Court Orders:

• If a court order requires us to do otherwise, we will comply after receiving a copy of it, which we will enter in the child's medical records.

Disruption to Medical Practice:

• Should issues between parents become disruptive to our medical practice, we reserve the right to discharge a family from our care.

To reflect the extra level and hours of service we provide, and to help track appointments that occur in the evenings or on weekends, insurance companies ask us to apply a special code to these visits. With that insurance code, there is a charge (currently $35) for all office visits after 5 pm and for all weekend visits.

Most private insurance companies, and all public insurance plans, cover this charge -- though, in some cases, it may be applied to your deductible. We want to let you know in advance, in case you want to check with your insurance provider about the specifics of your plan.

If you do contact your insurance company, ask about code 99051, which is the standard code used by insurance companies to identify a visit outside of the standard 8 am-5 pm, Monday-through-Friday time frame. If you have any questions for us, we're happy to answer them. Just give us a call in the office and ask to speak to the Billing Department.