Financial & Office Policies
Little Tigers Pediatric Therapy appreciates the confidence you have shown in choosing us to provide for your child’s needs. The service you have elected to participate in implies a financial responsibility on your part. It is our policy to make definite financial agreements with you before any treatment starts. Please understand that payment of your bill is con- sidered part of your child’s treatment. This Financial & Office Policies document is an agreement between Little Tigers Pediatric Therapy and the parent, guardian or other responsible party of the child. Your understanding of this document is important to our professional relationship.
Insurance Plans: Insurance is a contract between you and your insurance company. It is your responsibility to know your insurance policy benefits and to understand if your insurance has specific rules or regulations. As a courtesy to you, we will bill your insurance company directly for therapy services rendered if we are an IN-NETWORK provider for your specific plan. If you are unsure about your current health insurance policy benefits, you should contact your provider to learn the details about your benefits, out-of-pocket fees and coverage limits. I understand that all payment for services rendered that are “patient responsibility” including co-pays, coinsurance and any amounts expected to be applied to my deductible are due at the time of services. If my insurance provider applies payment toward my deductible, I am responsible for the full amount posted to my account. Any balance not covered by my insurance becomes my responsibility.
I understand that as a courtesy, Little Tigers Pediatric Therapy will bill my health insurance company directly for therapeutic services rendered. If problems arise regarding coverage issues, Little Tigers Pediatric Therapy will attempt to work with my insurance company to help resolve the issue prior to making it my responsibility. However, I understand that I am nevertheless ultimately responsible for payment of therapeutic services rendered by this clinic. Not all services provided by Little Tigers Pediatric Therapy are covered benefits under all insurance plans. If my claim is denied by my insurance carrier, I understand that I am responsible for paying Little Tigers Pediatric Therapy’s standard Private Pay rate for each of the therapeutic services rendered.
I understand that it is my responsibility to update Little Tigers Pediatric Therapy with my insurance information each time it changes. If I have provided incorrect insurance information and it precludes Little Tigers Pediatric Therapy from obtaining payment for services, I understand that the charges associated with my child’s treatment will be my responsibility.
Payments: If we are not In-Network with your insurance company, we are unable to bill your insurance company and we cannot accept assignment from them for the services performed. In this case, Little Tigers Pediatric Therapy will provide you with a Superbill that you may submit to your insurance company for reimbursement. Not all services provided by Little Tigers Pediatric Therapy are covered benefits under all insurance plans.
I understand that all payments are due at the time of service.
I understand that the parent or guardian accompanying my child to their treatment session is responsible for payment at the time of service. In the case of a divorce, I will not put Little Tigers Pediatric Therapy in the middle of marital disputes as a divorce decree is a legal document binding only on the two parties to it. It is my responsibility to work out payment of my child’s services between the custodial and non-custodial parent. Credit Card on File: I understand that Little Tigers Pediatric Therapy requires all parents to provide credit card information to be securely stored within the office. I will further review this policy on the Credit Card Consent Form I will sign when I put my card information on file. I understand that my child will not receive treatment without this information.
Cancellations & Late Arrivals: Little Tigers Pediatric Therapy has a 24 hour Cancellation Policy. Missed appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. It is both unfair to other patients and therapists to not allow for others to schedule in the open time slots. Please call our office at least 24 hours prior to your next scheduled appointment if you need to cancel. All cancellations must be made with the front office. Cancellations will not be accepted through your child’s therapist.
Should a cancellation take place within 24 hours of the scheduled appointment, you will be responsible for a Late Cancellation Fee of $50.00. Note: Insurance Companies DO NOT reimburse for Late Cancellafion Fees, this is the sole responsibility of the parent/guardian.
I understand that my child may lose their weekly scheduled appointment time if more than 3 unexcused cancellations occur within 1 month.
Consistent participation in therapy sessions allows for routine practice as well as faster progress toward therapy goals. Arriving on time to your scheduled appointment allows for your child to participate for the full length of their treatment session.
I agree to have my child arrive to all appointments on time and understand that if we are more than 15 minutes late without calling, my child will not be seen for treatment and that a Late Cancellation Fee will be incurred on my child’s account. Note: Insurance Companies DO NOT reimburse for Late Cancellafion Fees, this is the sole responsibility of the parent/guardian.
No Shows: Clients who do not keep their appointments deprive others of an opportunity to see their therapist. Little Tigers Pediatric Therapy requires 24 hour notice for canceling any appointments. Little Tigers Pediatric Therapy reserves the right to charge a No Show Fee in the amount of a Private Pay session if your child does not attend their scheduled session without prior notification. I understand that I will be charged a No Show Fee if I do not show up for a scheduled appointment. Note: Insurance Companies DO NOT reimburse for No Show Fees, this is the sole responsibility of the parent/guardian.
I understand that my child will lose their weekly scheduled appointment time if 3 appointments are missed without prior notification.
Collection of Past Due Accounts: We communicate with parents and guardians to resolve past due accounts. Monthly statements are sent out if there is a balance on a client’s account and payment is due within 10 days of receipt of a statement. If we cannot reach a parent or guardian by phone following a return of undeliverable mail, or if a client’s account cannot be paid as agreed, we will be forced to use the outside service of a professional collection agency. Please let us know when or if your contact information has changed so that we can always reach you, if needed to discuss past due accounts.
I understand that once an account is placed with a collection agency, Little Tigers Pediatric Therapy cannot take the account back and I will resolve the past due account directly with the collection agency.
My signature below signifies that I have read, understand and agree to abide by the terms of Little Tigers Pediatric Therapy’s Financial & Office Policies in order to provide my child Occupational Therapy, Physical Therapy and/or Speech-Language Therapy.
