The goal of Dakota Pediatrics, P.A. is to provide our patients with quality medical care at a reasonable fee. To avoid any misunderstanding with our patients, we have prepared this written policy which sets forth the details of our payment policy.
- Each child is treated as a separate account
- 0% monthly interest
- $1 statement/installment fee per outstanding claim, incurred everytime a statement is generated for that claim
- Minimum monthly payment of $10 or 10% of the current outstanding balance, whichever is greater, to avoid a late payment fee
- Payments are due on receipt
- $25 late payment fee
- $36 or 30% of current outstanding balance, whichever is greater, collections fee for any account referred to a collections agency or pre-collection agency
- $30 returned check fee for all returned checks
- In the event the patient/guarantor defaults under the terms of this agreement, patient/guarantor agrees to pay all costs of collection associated with collecting the amount owed, including any and all reasonable attorney fees
Your insurance coverage contract is an agreement between you and your insurance company. The amount your insurance company pays is determined under the terms of your contract. You are responsible for any amount not covered under your contract, as well as any pending insurance claims. It is also your responsibility to know your coverage plan, what services are covered and which services are not covered.
Copays are due at the time of service. The adult accompanying the child is responsible for the copay. This is a requirement of our contract with your insurance company. Copays not paid at the time of the visit will have a $25.00 surcharge added.
You will be billed monthly for services rendered. Only one statement will be sent per account. Please retain a copy of your invoice as Dakota Pediatrics, P.A. does not guarantee that any statements can be reproduced.
ACCEPTED FORMS OF PAYMENT
We accept cash, check, money order, and all major credit and debit cards.
If the minimum monthly payment is not received on your account while there is an outstanding balance, your account may be sent to collections. We always try to contact you prior to sending your account to our collections agency, however, we do not guarantee any additional written notice other than your monthly statement. Because of state law, any account that has been referred to our collections agency, including any associated accounts, will be unable to schedule future appointments until the total balance is paid or sufficient payment arrangements are made.
WHO IS RESPONSIBLE
We hold both parents separately and jointly liable for all outstanding charges unless we receive a copy of a court order which names someone else as having responsibility for health care costs –AND- reasonable and dependable arrangements can be made with that person for payment. If the patient is 18 years or older, the patient will be held responsible for all charges incurred.