INSURANCE:
Your current insurance card should be presented each time you come for an appointment, along with the subscriber’s date of birth. All medical claims will be submitted to your insurance carrier unless otherwise specified by the patient or guarantor. However, we do not have access to the terms of your insurance policy and cannot guarantee your insurance company will cover the services we provide. We recommend you call your insurance carrier directly for any questions. If you are covered by any of the following insurance plans, you are responsible for obtaining a referral from your primary care physician: Blue Plus, Health Partners (group #s 3080, 3081, & 4101), UHC Core Network, Prevea Health, Sanford Health, Medica Elect, Medical Essential, Medica Park Nicollet, Medica Ridgeview Comm Network, Medica VantagePlus, Iowa Medical Assistance (Amerigroup/AmeriHealth & Community Health Plan), Itasca Medical, Nebraska Medical Assistance, North Dakota Medical Assistance, South Dakota Medical Assistance, Wisconsin Medical Assistance, Tricare, or any other plan that requires a referral but is not listed.
CO-PAYMENTS AND DEDUCTIBLES:
Co-payment amounts are due on the day of your appointment and are to be paid when you check in. Payments can be made by cash, check, debit card, or credit card (Visa, MasterCard, Discover, and American Express accepted). Deductibles, non-covered services, and other amounts not paid by insurance are also the responsibility of the patient or guarantor.
ESTIMATED COSTS:
Your child’s initial visit will consist of a comprehensive evaluation. Depending on the complexity of the evaluation, the cost will range from $500 to $800. Additional tests such as Pulmonary Function Testing and X-rays may be necessary, which could incur additional charges. You may receive separate bills from Children’s Hospital for these tests. Additionally, if you receive any medical equipment during your visit, you may be billed separately by the durable medical equipment company.
STATEMENTS AND PAYMENT TERMS:
After your insurance company processes your claims, you will receive a statement for any remaining balance. Payment is due within 30 days of the statement date. We understand medical care can be unexpected and costly, so if you have financial concerns, please contact our billing office to discuss your situation. If you are unable to pay the balance in full before the due date, please call to set up a payment arrangement. The billing office is available from 8:00 a.m. – 4:00 p.m., Monday-Friday, and can be reached at (612) 813-3340 or toll-free 1-888-242-3327.
BILLING ERROR REVIEW:
If you believe your bill contains an error or if a third party should pay the bill, please contact our business office for a review. While we investigate, billing for the disputed services will be paused. Once the review is complete, we will notify you of any billing corrections or, if no changes are necessary, provide a detailed explanation. If an overpayment is found, we will refund the overpaid amount within 30 days of completing the review.
REFERRAL TO COLLECTION AGENCIES:
If we do not receive payment within 120 days of the statement date and acceptable payment arrangements have not been made, your account may be referred to a collection agency or law firm. Please note that we will not report your medical debt to a consumer credit reporting agency. Once your account is sent to collections, any further correspondence should be directed to the collection agency.
ENDING COLLECTION ACTIVITIES:
Collection activities will cease once the debt is either paid or deemed uncollectible, in accordance with our agreement with the collection agency or law firm. If you would like an update on your account status, please contact our business office.
NO DENIAL OF MEDICALLY NECESSARY SERVICES:
We will not deny medically necessary services to you or any member of your family due to current or past medical debt owed to us. If you or a family member has outstanding debt, we may require you to enroll in a payment plan for the amount owed. The payment plan will consider your financial ability, and if you are unable to meet the agreed payments, please communicate with us so we can adjust the plan accordingly.
PAYMENT PLANS:
If you are unable to pay your balance in full, our billing office will work with you to set up a reasonable payment plan based on your financial situation. It is important to communicate with our billing office if you are unable to make a payment. We will make every effort to accommodate your financial circumstances within the legal boundaries of the Minnesota Debt Fairness Act.
RESPONSIBILITY OF THE ACCOUNT:
All services rendered are the responsibility of the guarantor listed on the account. The guarantor of a minor will be the parent or guardian who is the subscriber on the insurance policy. By signing below, you accept the terms and conditions outlined in this policy, and you agree to be responsible for all charges not covered by insurance.