Pediatrics @ the Basin is committed to the right to privacy for our patients and web site visitors.

When a person visits our web site we may collect and track data from our site’s server. This information helps us to improve upon the content provided on our site. Information collected may include how long you spend on our site, the pages you visit, your browser and operating system types and the name of your internet service provider.  

Our web site provides the capability to request information on-line. To process your request, we may require that you provide us with personal identifying information. All information collected is held in complete confidence. It is our policy not to share the information with third parties for any reason, unless legally required to do so or as necessary to process your requests.

If you have any questions about our privacy policy or our use of information gathered through our web site, please contact us at         (585) 218-9560.

Pediatrics @ the Basin Financial Policy

We know that choosing a physician is a very important decision and we thank you for choosing our office.  We also recognize that insurance plans and payments have become increasingly more complex for our patients and their families.  We have developed some services to help with those complexities.   Please carefully read this overview of Pediatrics @ the Basin’s  financial policies.

Payment is due at the time of the visit.  This includes all co-pays, deductible and coinsurance  amounts. Co-pay amounts are listed on your insurance card.   All deductible plans must be paid in full at the time of the visit. 

Patient or Guarantor's Responsibility:

You will be responsible for any payment for any services requested and/or approved by you, if not covered by your insurance carrier. In addition, you will be responsible for any services rendered to your child(ren) for services requiring interpretation by an outside agency and billed by them directly (i.e. labs, etc.). 

You must be informed of and understand the details of your health insurance coverage and fulfill any associated requirements (e.g., pre-certification, obtaining referrals, providing information regarding pre-existing conditions, etc.). Obtaining these is the responsibility of the patient prior to the visit or the patient will be responsible for the total amount due.  It is also your responsibility to provide our office with all required information regarding your health insurance coverage.  You must promptly respond to our requests for insurance information and notify us if there are any changes to your insurance information.

Financial Services we can provide:

We provide the following financial services regarding care provided for yourself or your  child.

As a service, we will keep a copy of your insurance card on file and will submit an insurance claim on your behalf to your insurance company with the information you have provided us. 
Payment options at the time of service include cash, check and credit card or a signed prior authorization for payment.  

We recognize just how difficult it can be to understand all the details of your insurance plan. Therefore we  are willing to accept a prior authorization agreement that allows us to charge an approved credit card for the patient balance as determined by the insurance company once we have submitted  a claim and received  the explanation of benefits.   Please go to our secure website to complete the required information.  Pediatrics @ the Basin Prior Authorization

The most common reason for a claim being rejected is an ineligible policy or plan number.   In the case there is an incorrect number or other information, you will be billed for the full amount of the visit.

Financial Services we CANNOT provide:

It is the responsibility of the patient and/or parents/guardians to know what is covered and not covered by their insurance carrier.  If you are unsure, you must either pay in full for the visit or sign up for our prior authorization plan.

Loans -  we cannot loan people money to cover the cost of their services until such times they collect monies from their insurance companies.

Balances that remain outstanding for a period of 90 days or more may be referred to a collection agency or attorneys’ office. If an account is sent to collection, all collection fees and attorney fees will be added to the balance due.  Additionally, patients may be dismissed from the practice as per legally accepted protocols.

Agreement:

By signing below, I/we have selected Pediatrics @ the Basin  as my/our child’s pediatric primary care provider and attest that I accept the responsibility for full payment of all services rendered.  I/we also agree that we will:

• Provide  accurate insurance information for the patient and update Pediatrics @ the Basin with any changes in insurance.
• Make full payment or co-payment at the time of service including all deductibles OR enroll in our  prior authorization plan.
• Keep the account current through timely payments and communications required.
• Grant the right to collect all reasonable costs, billing fees, attorney’s fees, collection agency fees and disbursements associated with any legal action taken to recover a debt for services rendered.

I/we understand that:

• All accounts not current are subject to Pediatrics @ the Basin  collection program and could result in a loss of privileges/relationship with Pediatrics @ the Basin.
• In the event the bank returns a check to us, a service charge of $40 (maximum) in addition to any bank fee will be added to the account.

Financial hardship should never stand in the way of medical care. Since open communication can benefit both parties, any hardship should be confidentially discussed with Pediatrics @ the Basin  earlier rather than later. This will simplify a difficult situation. Please feel free to speak with the your physician or our office manager if you have any questions about our policy.

I HAVE READ AND UNDERSTAND THE TERMS AND CONDITIONS SET FORTH ABOVE AND AGREE TO THE TERMS AND CONDITIONS THEREIN. I FURTHER UNDERSTAND THAT FAILURE TO COMPLY WITH THIS AND ANY OTHER POLICIES OF Pediatrics @ the Basin MAY RESULT IN TERMINATION OF PROFESSIONAL SERVICES. (A DUPLICATE COPY OF THE BILLING AND CREDIT POLICY IS AVAILABLE FOR MY REFERENCE, UPON REQUEST).