Policies

For the last decade, MPA has had a policy in place that requires all our patients to be fully immunized per the schedule published by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control. The only variations we have allowed have been to delay or exclude the live virus vaccines (MMR and chickenpox) when either the patient's or a family member's medical condition made administering those vaccines dangerous to the affected person. We have also postponed immunizations when a patient was undergoing chemotherapy or any other therapy, which would have made receiving such immunization dangerous.Recently, we have received several requests from parents to allow different immunization schedules from the one that we use. We have not granted and will continue to disallow such requests unless we receive valid medical justification for the request.

Many of the requests are for an 'alternative' schedule, as proposed by some authors. Others are for 'delayed' administration of the immunizations. We support the AAP/ ACIP schedule because it has been developed with many years of research and validation by sound scientific methods, and we know from our experience that it is a safe and effective schedule. None of the alternative or delayed schedules have been validated, and we, therefore choose to continue with our policy.

We invite questions from our patients and parents and will do our best to answer them fully, thereby alleviating any concerns or fears you may have. We will not authorize an 'alternative' schedule that is not medically justified. It is therefore against our medical advice as professionals at Midland Pediatric Associates.

Thank you for selecting Midland Pediatrics as your Medical Home. Payment for services is due at the time services are rendered, regardless of whom you choose to send with the patient at the time of his/her appointment. For any portion of your balance, including deductibles, co-insurance, and non-covered charges, that are not covered by your insurance will be billed to you as patient responsibility (i.e., the responsibility of the patient’s guarantor). Note that whomever you indicate as Family Contact #1 will be marked as the Guarantor for billing purposes. This means all messages that are automated in our system go to that contact, and mail/email correspondence for general or billing purposes will also go to that contact. We will accept payment via credit card (Visa, MasterCard, American Express, or Discover), cash, or check. Any checks that do not clear when deposited will receive a $25.00 check fee and the patient’s account will be noted that payments by checks are no longer accepted.

INSURANCE CARDS

Please be prepared to show your insurance card at each visit.  This is a requirement for this office to file your charge with your insurance.  If you do not have the current information, this office will not file the claim, and the entire visit will be the parent's responsibility.  Currently, we are not in contract with any Medicaid policies or share plans. I understand that MPA will bill the primary insurance company for services rendered.  I will be responsible for paying for any services not covered by the primary insurance.  I understand MPA will not file secondary claims to Medicaid for services provided. 

EXTENDED PAYMENT ARRANGEMENTS

For procedures exceeding $300.00 - 50% of the total fee from an office visit is to be paid at the time of service.  The remaining balance is to be paid over the next 3 months in equal monthly payments due by the due date arranged in the payment agreement.  Patients who fail to make a monthly payment may be sent to a collection agency and may be dismissed from the practice.

COLLECTIONS

We are committed in making every effort to supply and contact a guarantor of any balances on accounts at a minimum of 3 times prior to the system converting the account into collections if balances are left unpaid for 90days. If the balance remains unpaid for more than 90days, the system recognizes this as a violation of the financial policy, acquired by an outside collection agency, and the family may be dismissed.  (Dismissal includes the entire family.)

This financial policy helps the clinic provide quality care to our valued patients.  If you have any questions or need clarification of any of the above policies, please feel free to contact us.

Family Administrative Fee_2022-11-01

Midland Pediatric Associates' clinicians are committed to your child’s health and wellness.

We work together closely to create the best possible experience for your family. Our goal as an independent pediatric practice is to provide the BEST medical care in a personalized way. We are the starting place for any of your health concerns, focusing on prevention, treatment of the whole child and coordination of care with specialists if needed. However, the many changes in the healthcare landscape have created a challenge for private practices – where physicians and their staff are required to spend increasing time on tasks that are not paid for by health insurance – such as phone calls, insurance authorizations, electronic prescriptions, controlled substance regulations, form completion, letters to school and coordination of care with specialists.

To focus on patient care and allow our clinicians to stay independent, we now charge an annual fee to cover these non-reimbursable administrative tasks and services.

This is above and beyond your customary insurance payment for services rendered. Unfortunately, your insurance will NOT pay these fees.

When you come to our office, you will only be seen by a board-certified Pediatrician or Nurse Practitioner. We have many urgent care appointments available each day and strive to see each patient who calls for a sick visit within 24 hours, given our walk-in hours. Keeping our patients healthy is our top priority, and we strive to make your experience with us as compassionate, kind, and stress-free as possible.

You have undoubtedly noticed that your medical insurance premiums have been increasing annually. What you have not seen is that the reimbursement to our practice from your insurers has decreased every year and that the costs of running the practice have increased substantively each year.

The administrative fee schedule will be:

• Family with one child: $100/year
• Family with two children: $125/year
• Family with three (or more) children: $150/year

The yearly fee is due by December 31. This must be paid to have your children continue as patients of MPA. Please be advised that payment of the administrative fee does NOT relieve you of responsibility for payment of co-payments, deductibles, co-insurance, or other charges determined to be non-covered by your insurance plan and is NON-Refundable.

Please understand that we are not making this decision without careful thought. We value each of our families and their children and appreciate being entrusted with their care. We believe this charge will allow us to continue delivering the same high level of care as we have for the last 35 years.

Sincerely,

Wayne L. Sager, MD

Annual Administrative Fee FAQ’s

Effective 1/1/2023, MPA will require all families to pay an administrative fee annually to continue as, or to become, a patient of the practice.

1. What is the annual fee?

*The annual fee is for all families per calendar year.

2. Do you still take private insurance?

*Yes, we will continue to take most private insurances.

3. Is this fee mandatory?

*Yes, this fee is required to continue as, or to become, a patient of our practice.

4. Will my private insurance reimburse the annual fee?

*No, this fee is not covered by your insurance. It will not be billed to your insurer.

5. What are my payment options for the annual fee?

*You may pay at the time of your visit.

6. Can I use my flexible medical spending account to pay this fee?

*You are advised to consult with your FSA or HSA plan administrator, employer or HR representative to clarify qualification in your particular circumstance. If needed, you may request a payment receipt for the fee.

7. When is the fee due?

*The fee is due in full each calendar year at the time of the first visit with any one of the providers.

8. Is any portion of the administrative fee refundable? For example, if I transfer to another practice or move away, will I receive a partial refund?

*No, the administrative fee is not refundable in part or full once it is paid for the calendar year.

9. If I see a provider in November for my first visit of the year and pay my administrative fee, and then have a follow-up in February, is my fee due again at that appointment?

Yes, because February is the first visit in the new calendar year.

10. Will I continue to be required to pay my co-pay/co-insurance? Will the annual fee count toward my deductible?

*Co-pays/co-insurance and deductibles will continue to be required and are unrelated and unaffected by the annual fee.