Financial Agreement between Guarantor, POP NOW, and Potomac Pediatrics

In return for services provided by POP NOW at Potomac Pediatrics, we expect payment or satisfactory financial arrangements, at the time the service is rendered. Our physicians are participating providers with many health insurances. We recommend that you verify your plans participation with Potomac Pediatrics as financial responsibility ultimately falls to the Guarantor of each account.

Your insurance policy is a contract between you and your insurance carrier. Thus, it is your responsibility to understand and know the provisions of payment for services rendered at Potomac Pediatrics (POP NOW). Please know any co-payment, coinsurance and deductible amounts and be prepared to make payment at the time of service.

Financial Responsibility

The Guarantor for the child’s policy is ultimately responsible for all co-payment, co-insurance, and deductible amounts, unless other legal arrangements are in place for two coparents. Additionally, the guarantor is responsible for all charges and supplies that are not covered by the insurer.

Payment will be collected at the time of service for any known account balance in addition to any co-payment amount. We are a cashless office. Acceptable forms of payment include personal checks or credit cards. Returned checks are subject to the return check fee of $35. The account will be debited for this amount on top of the original amount of the transaction. After one returned check, we will no longer accept personal checks on your account.

Shared Custody Financial Policy

We are not financial mediators between separated/divorced parents. The parent that is bringing the child in for a visit will be required to remit payment at the time of service for any copays/deductibles/coinsurances AND put their credit card on file for any remaining statement balances from that visit. If the parent that is bringing the child in for a visit is unwilling to comply with this policy they will be referred back to their PCP and/or to another urgent care facility for same day care. We are happy to provide receipts for any payments collected should one parent need to seek reimbursement from another.

Copayments, Deductibles, and Coinsurance

Copayments, deductibles, and coinsurance amounts are contractual arrangements between a Guarantor and their insurance plan, and between Potomac Pediatrics and our insurance plans. As these are contractual arrangements, Potomac Pediatrics cannot waive copayments, coinsurance, or deductibles for any patient. Copays are due at the time of service and will not be billed to you. If you have a deductible, then a deductible deposit of $100 will be due at the time of service, for each visit, and each child until your deductible has been met. .

Our office will make every attempt to verify your insurance benefits and remaining deductible amounts due on your policy. Occasionally your insurance plan may not provide us with the most up-to-date deductible information. However, we must collect any deductible deposit, copay, or coinsurance due based on the current information that has been provided to our office.

Proof of Insurance

Patients should alert front desk staff of any insurance changes prior to being seen. Adequate proof of insurance is required at all visits; be prepared to show a current insurance card. If adequate proof of insurance is not established prior to the appointment, you will be financially responsible for the entire visit at the time services are rendered. Should you wish to submit to insurance on your own, we will provide adequate documentation to aid in that process.