FINANCIAL POLICY Each patient must have a guarantor who is responsible for timely payment of:

• Co-pays and non-covered services.
• Co-insurance and deductibles.
• Fees for service if private pay.
• Additional fees for forms, missed co-pays, returned checks, missed appointment or collection charges.

Before your first visit or after a change in coverage, confirm with our staff that we participate in your insurance plan. Read and sign our Financial Agreement & Authorization for Treatment form before services are rendered. We are required by insurance companies to receive a current and accurate insurance card at each visit to ensure timely filing of claims.

In the case of divorced parents, we cannot become involved in shared payment arrangements. The person who accompanies the child should be prepared and responsible for the necessary payment.

Our billing staff is available to help with questions and problems. Call 203.972.5233.

URGENT WEEKEND CARE If you require urgent care over the weekend, we are open on Saturday and Sunday mornings. Please call at 8:30 am for an appointment.

HIPAA UPDATE In order to protect Personal Health information (PHI) in accordance with government regulations, we may not share your PHI with schools, daycare, or camps without written consent via the” HIPAA AUTHORIZATION FOR RELEASE OF PATIENT RECORDS-Partial” form. We may share an Immunization Record Only with verbal parental consent. All other medication, health, sports, camp or absence forms require a written release form. We appreciate your understanding that our staff must follow government requirements.

18 YEAR OLD POLICY Patients who reach their 18th birthday are considered adults with regard to healthcare decisions. Their personal health information becomes protected from their parents regardless of the guarantor/insurance holder.

• If a patient wishes, we will continue to provide care until 22 years of age. By age 22, patients must transfer care to another physician.
• At age 18, we provide a packet that includes a summary of the conditions for care, particularly for those patients living away from home. We require a signed letter agreement from each patient acknowledging acceptance of those conditions along with private contact information. Each 18 year old can also sign a Consent to Release Patient Information form and may designate which type of medical information may be shared and with whom. Only with this permission may we discuss the patient's care with parents.
• If you choose not to remain with New England Pediatrics after age 18, please arrange for transfer of care to an internist, family physician or gynecologist. A list of recommended physicians is included with the 18 year old packet. Transferred records are maintained for seven years after the last visit, and then are destroyed.