Emergency Room & Urgent Care Center Policy
Billing and Payment Policy
We are pleased that you have chosen our practice to manage your child’s health care needs. Personal and compassionate care is the first priority amongst our staff. To keep the cost of your healthcare to a minimum, Westwood-Mansfield Pediatric Associates requests that you please review the guidelines below.
Insurance and Billing
We accept most insurance plans including:
|Aetna||First Health/CCN Network (HCVM)||Tri-Care|
|Blue Cross/Blue Shield||Great-West Health Care||Tufts Health Plan|
|BMC HealthNet||Harvard Pilgrim Health Care||Unicare|
|Cigna||Mass Health||United Healthcare|
|Fallon Community Health Plan||Private Healthcare Systems (PHCS)|
Please be sure to bring your child’s insurance card with you each time you visit the office.
Self Pay Patients
Please arrive prepared to make payment in full at the time of service.
- Payment for services provided in the physician’s office is expected at the conclusion of your visit.
- For your convenience, we accept cash, check and credit card payments.
- For balances after insurance payment, family statements are mailed monthly. Payment in full is expected upon receipt of the statement. For our patients with financial difficulty, we do offer monthly payment arrangements. Please contact our Billing department to arrange a mutually agreeable payment plan.
Patients with Health Insurance
Insurance is an arrangement between an individual and an insurance company (and sometimes an employer) to help pay the cost of medical care. Each plan has individual limitations as to what it specifically covers. Due to variations in deductible and co-payment requirements, insurance rarely covers the entire bill. Because of the many different insurance plans and coverage types available, it is impossible for Westwood-Mansfield Pediatric Associates to be familiar with each insurance arrangement. As a courtesy, Westwood-Mansfield Pediatric Associates will present a bill for services rendered to your child’s health insurance carrier, but it is ultimately the parent/guardian’s responsibility to ensure all services are paid in full.
It is the responsibility of the parent/guardian to know and understand the details of their child’s health insurance coverage. Not all services may be covered by your child’s health insurance plan. Therefore, the obligation to understand what services are covered remains the responsibility of the parent/guardian.
Co-payments and any prior patient balance will be collected at the time of service.
Due to filing limitations with many insurance carriers, it is the parent/guardians responsibility to inform Westwood-Mansfield Pediatric Associates of their child’s health insurance coverage at the time of each visit. Parents/Guardians who do not present their child’s insurance card at the time of the visit may be required to pay for the service. You may be required to sign a non-covered services waiver so that we can bill you directly.
Although your child may be scheduled for a particular type of visit, the provider of service may deem it in the best interest of your child to address other matters of concern which were not originally planned at the time the appointment was scheduled. This may result in another charge billed to your insurance carrier and possibly an insurance/patient cost sharing (deductibles, co-payments and/or co-insurance). This is a widely acceptable industry standard of care. If you have any questions regarding services rendered, please feel free to contact our office.
HMO Insurance Plans
Primary Care Physician Selection
Your insurance plan may require your notification of the Primary Care Physician (PCP) you have selected to manage your child’s healthcare. If this notification is not on file with your insurance plan, services may be denied leaving the entire balance your responsibility. Please notify your insurance carrier promptly of the PCP you have selected for your child.
Services Requiring Referral/Pre-Certification or Authorization
Your insurance may not pay for certain visit or services which have not been referred by your Primary Care Physician (PCP). You are, therefore, responsible to confirm that the Westwood-Mansfield Pediatric Associates Referral Coordinator receives the appropriate referral, pre-certification or authorization details to initiate a valid referral. Please check with our referral coordinator to confirm a referral has been processed prior to receiving specialists services. If we do not receive this information prior to the specialist appointment, you may be financially liable for these services.
Westwood-Mansfield Pediatric Associates may charge a “No Show” fee for missed appointments or for appointments canceled without 24 hours notice. We regret that we have determined it necessary to institute this policy. However, by canceling your appointment 24 hours or more prior to the appointment, you will avoid this fee.
As a courtesy, the practice makes every effort to make appointment reminder calls for most non-urgent appointments, however, should this courtesy not occur and the appointment is missed, the charge is still applied and payment expected.
All patient balances must be paid in full within 30 days of receiving a bill from Westwood-Mansfield Pediatric Associates. If you have not paid your balance in full within ninety (90) days after the date of the original bill, your account will be reviewed for collection agency placement. You will be held responsible for your entire balance.
Records and Forms
We require a minimum of 48 hours notice for a medial records and form request.
WMPA will charge $5.00 per child to reproduce his/her medical record and payment is due upon receipt. We may increase this fee for excessively large records over 20 pages.
Medical forms, including but not limited to, athletic, camp, college entrance will be prepared with a charge of $5.00 per form, per child and payment is due upon receipt.
Patient/guarantor payments resulting in an overpayment on the account will be refunded upon scheduled review of the account or upon parent/guardian request. Refunds under $5.00 will be processed by request only.
Any guarantor payments in the form of checks that are returned from the bank as unpaid will be charged back to the guarantor. In addition, a $20.00 bank fee will be charged to your account which will remain the responsibility of the guarantor.
Office No-Show and Late Policies
Physical exam and consultation time slots are precious and very much in demand. In an effort to serve you better, we ask for proper notice for any cancellation. Patients failing to provide at least a 24-hour notice will be charged $50 for any missed appointment.
We make every effort to be on time for all our appointments. Unfortunately, when even one patient arrives late, it can throw off the entire schedule for that session. In addition, rushing or “squeezing in” an appointment shortchanges the patient and contributes to decreased quality of care (and increases medical errors). In light of this, patients arriving more than 15 minutes after their appointment time will be asked to reschedule. We apologize for any inconvenience this might cause.
Any child requiring emergency care will be seen as soon as possible.
Notice of Patient Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.If you have any questions about this Notice, please contact our Privacy Officer at the number listed at the end of this Notice.
Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This Notice applies to all of the records of your care generated by your health care provider.
Westwood-Mansfield Pediatric Associates, P.C. is required by law to maintain the privacy of your health information and to provide you with a description of our legal duties and privacy practices regarding your health information. The current Notice will be posted in the main reception area. The notice will include the effective date. In addition, we will make our best effort to provide you with a copy of this notice that we request you acknowledge with your signature.
We are required by law to abide by the terms of this Notice and notify you if we make changes to this Notice, which may be at any time. Changes to the Notice will apply to your medical information that we already maintain as well as new information received after the change occurs. If we change our Notice, it will be posted in the main reception area. You may also request that a revised Notice be sent to you in the mail or you may ask for one at your next appointment or appropriate visit. This Notice will also serve to advise you as to your rights with regard to your medical information.
How We May Use and Disclose Medical Information About You
The following categories describe examples of the way we use and disclose medical information:
- For Treatment: We may use medical information about you to provide, coordinate and manage your treatment or services. We may disclose medical information about you to other doctors, nurses, technicians (e.g. clinical laboratories or imaging companies), medical students, or other personnel who are involved in your care. We may communicate your information either orally or in writing by mail or facsimile.We may also provide a subsequent healthcare provider with copies of various reports that should assist him or her in treating you. For example, your medical information may be provided to a physician to whom you have been referred so as to ensure that the physician has appropriate information regarding your previous treatment and diagnosis.
- For Payment: We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information before it approves or pays for the health care services we recommend for you.
- For Health Care Operations: We may use or disclose, as needed, your health information in order to support our business activities. These activities may include, but are not limited to quality assessment activities, employee review activities, licensing, legal advice, accounting support, information systems support and conducting or arranging for other business activities. In addition, we may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contatct you to remind you of your appointment by telephone or reminder card.
- Business Associates: There are some services provided in our organization through contracts with business associates. Examples include software support. If these services are contracted, we may disclose your health information to our business associate so that they can perform the job that we have asked them to do and bill you or your third-party paer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information through a written contract.
Other Permitted and Required Uses and Disclosures That May Be Made with Your Consent, Authorization or Opportunity to Object
We may also use or disclose your health information as set forth below. You have the opportunity to agree or object to the use or disclosure of all or part of your health information in these instances. If you are not present or able to agree or object to the use or disclosure of the health information (such as in an emergency situation), then your clinician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the information that is relevant to your health care will be disclosed.
- Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may release medical information about you to a friend or family member who is involved in your medical care or who helps to pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
- Future Communications: We may communicate to you via newsletters, mailings or other means regarding treatment options, information on health-related benefits or services; to remind you that you have an appointment for medical care; or other community based initiatives or activities in which our facility is participating. If you are not interested in receiving these materials, please contact our Privacy Officer.
Other Permitted and Required Uses and Disclosures That May Be Made without Your Authorization or Opportunity to Object
We may use or disclose your health information in the following situations without your authorization or without providing you with an opportunity to object. These situations include:
1. As required by law. We may use and disclose health information to the following types of entities, including but not limited to:
- Food and Drug Administration
- Public Health or Legal Authorities charged with preventing or controlling disease, injury or disability
- Correctional Institutions
- Workers Compensation Agents
- Organ and Tissue Donation Organizations
- Military Command Authorities
- Health Oversight Agencies
- Funeral Directors, Coroners, and Medical Directors
- National Security and Intelligence Agencies
- Protective Services for the President and Others
- Authority that receives reports on abuse and neglect
2. Law Enforcement/Legal Proceedings: We may disclose health information for enforcement purposes as required by law or in response to a valid subpoena.
3. State-Specific Requirements: Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs.
Your Health Information Rights
Although your health record is the physical property of the Westwood-Mansfield Pediatric Associates, P.C. that compiled it, you have the right to:
- Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. We ask that you submit these requests in writing. Usually, this includes medical and billing records, but does not include psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Requests for access to and copies of your medical information must be submitted to Westwood-Mansfield Pediatric Associates, P.C. in writing. No cost at this time.
- Amend: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information by submitting a request in writing. You have the right to request an amendment for as long as we keep the information. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.
- An Accounting of Disclosures: You have the right to request an accounting of our disclosures of medical information about you except for certain circumstances, including disclosures for treatment, payment, health care operations or where you specifically authorized a disclosure. Westwood-Mansfield Pediatric Associates, P.C. will provide the first accounting to you in any 12-month period without charge. The cost for subsequent requests for an accounting within the 12-month period will be $0.00. We ask that you submit these requests in writing.
- Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or for the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a procedure that you had. We ask that you submit these requests in writing.We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
- Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes. We ask that you submit these requests in writing.
- A Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.To exercise any of your rights, please obtain the required forms from the Privacy Officer and submit your request in writing.
If you believe your privacy rights have been violated, you may file a complaint with us by calling (781) 234-1931 and asking for the Privacy Officer or by contacting the Secretary of the Federal Department of Health and Human Services. All complaints must be also submitted in writing. You will not be penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. However, we are unable to take back any disclosures we have already made with your permission and we are required to retain our records of the care that we provided to you.
Privacy Officer: Carol O’Neill
Telephone Number: (781) 234-1931
Dear Families,Congratulations on being the parent of an almost-teenager!
Over the past decade, we have worked together with you to help keep your child safe and healthy. As your child approaches adolescence, this collaboration begins to change in order to allow your teenager to assume more responsibility for his or her own healthcare. As part of this transition, starting at your child’s 13 year-old check up, your child will be encouraged to meet with the clinician without a parent present for the majority of the visit.
In order to facilitate this transition parents will be asked to fill out a comprehensive questionnaire about their teenager and will have an opportunity to discuss major concerns with the provider, however the majority of the visit will be conducted without the parent present. Based on a specific child’s needs, on occasion, there may be an exception to this plan. Additionally, teenagers will always have the option of requesting a nurse to be in the room as a “chaperone.”
We at Westwood-Mansfield Pediatrics Associates are committed to empowering our adolescent patients to know and to understand their own pertinent medical and family history. We encourage you to inform and educate them about their chronic medical conditions, any medications (including vitamins and supplements) they are taking, and any allergies they may have. Being able to manage one’s own health care as an adolescent is an important step in the process of eventually transferring to adult-centered care.
Gradually shifting responsibility for health-related tasks at this developmentally appropriate time gives adolescents the knowledge, skills and experience necessary to become independent, and eventually manage their own health conditions. We can help our teenagers become informed and empowered young adults.
Please help your child with this process by making him or her aware of our patient portal and how to use it to contact us with questions. Additionally, we recommend all teens and young adults program the following information into their phone (consider password protecting):
- Any health issues (asthma, ADHD, allergic rhinitis, diabetes, high cholesterol, etc…)
- Any allergies to medications
- Date of the last tetanus shot
- Any current medications (including over the counter medicines, vitamins and supplements) including the dosage and frequency of administration
- Our office number as well as the names and phone numbers of any specialists they have seen
The early teenage years can be very exciting and challenging as your child strives to develop a sense of individuality. We look forward to our new collaboration with you AND your teen!
Westwood-Mansfield Pediatric Associates
Recommended Book: The Complete and Authoritative Guide to Caring For Your Teenager: The American Academy of Pediatrics
We at Westwood-Mansfield Pediatric Associates firmly believe that immunizations are one of the most important medical breakthroughs of the last century. Vaccines are important for your child. Vaccines save lives.We are a Pro-Vaccine Practice. We expect parents to immunize their children according to the schedule recommended by the American Academy of Pediatrics (AAP). Parents who refuse to vaccinate their children according to the Massachusetts School Immunization Requirements are not a good fit for our practice and will be asked to leave.
The AAP and the Center for Disease Control and Prevention (CDC) both recommend administering multiple immunizations at each visit and not “splitting” vaccines. Multiple shots and combination vaccines are utilized for three main reasons:
to provide broad immunologic protection to children when they are young and most vulnerable
to minimize the absolute number of shots needed
to minimize the number of office visits, and thus the likelihood of medical error and the cost to the health care system
Administration of simultaneous immunizations has been extensively studied and determined to be safe and efficacious. There is no negative effect on the normal childhood immune system. There is no medical benefit to splitting shots (and there is increased potential for harm by doing so).
We at Westwood-Mansfield Pediatric Associates strongly support these recommendations. Splitting vaccines leads to medical errors and increases risk to the undervaccinated child, In addition, it poses a risk to other children in our practice who may come into contact with your child.Parents who insist on diverging from the recommended vaccine schedule will be asked to sign a waiver stating that they are aware of the potential risks inherent in doing so (including, but not limited to, decreased immunity to potential life-threatening infections), as well as the lack of medical benefit from splitting shots. In addition, the parents will be asked provide (in writing) their proposed vaccine schedule for provider approval. Families who fail to adhere to this alternate schedule (once agreed upon) or parents unwilling to sign the waiver will be asked to leave the practice.
We are happy to provide you with literature and websites on vaccines, as well as to answer any and all questions you may have.
Thank you for entrusting us with the care of your children.
Westwood-Mansfield Pediatric Associates
Proactive in Your Child’s Care!
(for more information: http://www.cdc.gov/vaccines)
Adolescent Confidentiality Policy
At Westwood Mansfield Pediatric Associates, we recognize that adolescence is an important time of transition toward adulthood. During this period of transition, we are committed to empowering our adolescent patients to assume more responsibility for their own healthcare. In an effort to provide the best quality of care for our adolescent patients please be aware of the following:
Beginning at age 13, each patient will be encouraged to meet with a clinician for a portion of the visit without a parent present. We believe that this private time provides an opportunity to discuss sensitive topics that an adolescent may not feel comfortable addressing otherwise. During this time, a teenager will always have the option of requesting a nurse to be present in the room as a “chaperone” if they desire.
The information discussed by an adolescent and the clinician is considered private and confidential. This means that it will not be shared with anyone without the permission of the adolescent. While this information is considered confidential, we always encourage our adolescent patients to be open and honest with their parents and can often help facilitate the process of sharing sensitive information. The confidentiality parameters noted above extend beyond the visit in our office and may include telephone calls. For this reason, we routinely collect the cell phone numbers of our adolescent patients.
The only time that we would break confidentiality is in the rare circumstance that we think a patient poses a severe risk to him/herself or another person, or if there is concern for immediate risk of life or limb.
This policy is consistent with Massachusetts state law surrounding adolescent confidentiality as well as the policies of the American Academy of Pediatrics and the Society for Adolescent Medicine. If you have specific questions or concerns about this policy please share them with your healthcare provider.