Children's Medical Group of Greenwich Financial Policy

In order to provide and maintain a good physician-patient relationship, we feel that it is important to advise you of our financial policy to avoid any misunderstanding. Please read this carefully, and if you have any questions, please do not hesitate of ask a member of our staff.

• Patients are expected to pay for medical care and insurance co-payments at the time of each office visit. Personal check, cash, and credit cards (Mastercard, Visa, American Express and Discover) are acceptable forms of payment.
• Payments for unpaid medical care are due within thirty (30) days of receipt of our statement for services.
• Per your insurance plan, you are responsible for any and all co-payments, deductibles, and coinsurances. Not all services provided by our office are covered by every plan. Any service not covered by your plan will be your responsibility and you will be billed. It is your responsibility to understand your benefit plan as this is an agreement between you and your insurance company.
• Should families experience financial difficulties, patients may make special arrangements with CMG for timed partial payments of larger medical bills. Please contact us if you are in need of special arrangements.
• Insurance co-pays are due at the time of service and will be expected at every visit. A $25.00 fee will be charged in addition to your co-pay if the co-pay is not paid at the time of service or by the end of business day.
• Please bring proof of insurance to each and every office visit! We can not accept any insurance that can not be verified. We will have to bill you directly until you can provide proof of insurance. If the insurance that you designate is incorrect, you are responsible for any balance.
• We do not submit to secondary insurance plans. At the end of the visit we will provide you with a detailed receipt for you to submit for reimbursement. You are responsible for any balance on your account
• Prior to making an annual physical appointment, please verify with your insurance company that the physical will be covered as not all plans cover annual healthy physicals.
• For all services rendered to minors, the adult accompanying the patient is responsible for payment, whether a parent/legal guardian or not. If your child will be brought to our office by a babysitter, grandparent etc, be sure to arrange for payment of insurance co-payment. Credit card payment can be made on the phone prior to the appointment or a credit card can be kept on file in our office.
• We bill monthly for unpaid balances. If any portion of a bill has been outstanding for greater than 90 days, patients will receive a certified letter of notification. Upon this notification, the entire balance will be due within ten (10) days of receipt of the notification unless prior arrangements are in place and a payment schedule is being followed.
• Should patients fail to pay the full outstanding balance within ten (10) days of notification, we will forward the account to a national collection agency. Accounts forwarded for collection will be placed in our inactive file, and patients will be notified of the discontinuation of Children’s Medical Group’s services by certified mail. We will continue to provide care for a thirty (30) day period from receipt of certified letter. Payment in cash is expected at the time of visit during these thirty (30) days. It is strongly recommended that families make alternate plans to find a new physician to ensure there is no lapse in medical coverage for their child(ren). We will send medical records to your newly named physician upon receipt of your authorization to do so. After the thirty (30) day period we will no longer be responsible for the patient’s care.
• Checks returned to our bank for insufficient funds will incur a service charge of $25.00 per incident, plus any related bank charges.
• Upon signed authorization to do so, CMG will transfer patient’s records for a fee of $0.75 per page, or for a pre-paid $20.00 flat fee.
• We reserve the right to terminate the physician-patient relationship for.
• Inappropriate behavior or language to staff or other patients.
• Falsifying insurance or health information.
• Repeated abuse of office policies such as repeatedly missing scheduled appointments.
• Past due accounts when the patient’s family does not make a good faith effort to make andmeet a payment schedule.
• There is a $10.00 fee, per form, for all medication/school/sports forms. Please allow 1 week for the completion of forms, unless the form is delivered at the time of visit.

I have received, and will abide by, the financial policy of Children’s Medical Group of Greenwich, P.C.