New Patients
We welcome you and are excited that you’ve chosen us to be your child’s medical home!
When calling to set up a new patient appointment, you will be in contact with one of our schedulers who will create your child’s chart. We will need information such as the patient’s demographics, approved family contacts (who is allowed to bring the child to appointments), and valid insurance information. We will also need your child’s records sent to us from the previous pediatrician. In order for the physician to see your child for their first physical exam with us, we will need the child’s vaccination record. The physician will not see the patient without this. If you have any questions regarding vaccinations and Pediatric Affiliates, please refer to the Vaccine Policy.
If you have multiple children in your family, Pediatric Affiliates will only see one child per day as a new patient; however, once the family is established, we will see two children in the same day.
If you have any questions regarding what to expect, where we are located, insurance inquiries, etc. please give us a call and one of our staff members will be happy to help you!
Phreesia Check-In System
Pediatric Affiliates uses Phreesia as our patient check-in and registration system. This system is designed to allow patients/parents to fill out the in-office paperwork from their mobile device up to two days prior to the appointment. The patients/parents also have the option to pay their co-pay/balance and upload pictures of their insurance information.
It is important to note that when using Phreesia, you are entering a secure and time sensitive link- this means that all fields and surveys MUST be filled out at ONE TIME, without leaving the site. Jumping in and out of the link will cause your registration information to not be completed properly.
Face Masks
As of March 21, 2023, masks are only required for patients over the age of 4 who are exhibiting active sick symptoms such as coughing, sneezing, fever, runny nose, etc.
Phone Protocol and Questions for the Physicians
Oftentimes, parents may have questions regarding OTC dosages, changes in formula, clarification of lab results, etc. If your question is regarding symptomatic treatment and OTC dosages, we ask that you please check the ‘Get Smart’ and the ‘Handouts’ section to look for symptomatic treatment advice prior to calling the office. During office hours, one of our staff members will happily take a message to pass on to one of the physicians. Please note that any non-emergency questions for the physicians will be forwarded to them in the order in which they were received. The turnaround time for the doctor to reply to non-emergency questions is 24 to 48 business hours. Once an answer is received by the physician, the staff member will reach out and touch base with you.
After hours, one of the physicians will be on call for urgent or medical emergencies ONLY. Any non-emergency questions or messages received by our answering service (such as appointment requests, prescription refills, etc.) will be followed up on by one of our staff members on the following business day.
Missed Appointments
We understand there are occasions when a situation arises where you cannot keep your appointment. Our Practice sends out confirmation text messages (and emails, if this is your preferred method of contact) 1 to 2 days prior to the appointment. Please call us if you feel that you cannot make your appointment. Patients who do not call and do not arrive to their appointment will be considered as a missed appointment. If you call after the close of business on the day prior to your appointment to cancel OR reschedule, we will also consider this as a missed appointment.
New patients who miss their appointment will be subjected to either a $50 missed appointment fee or dismissal from the practice as outlined and determined by insurance guidelines.
Established patients are allowed ONE missed appointment PER FAMILY AND PER CALENDAR YEAR. If the family has a second missed appointment within the year, the family will be charged a no-show fee or dismissal from the practice as outlined and determined by insurance guidelines. Our current no-show fee is $50.00 PER 15 MINUTE TIME SLOT. Please be advised that most behavioral health visits are 30 to 45 minutes, which can result in a $100-150 no-show fee.
Late Appointments
If a patient arrives more than 15 minutes later than the scheduled appointment time, then it will be up to the physician’s discretion of when they can (and if) work the patient into their schedule. The parent/patient may have to wait a prolonged period of time to be seen.
Surveys/Questionnaires
For all well visits and mental health/behavior visits, the patient/parents will receive surveys that need to be completed prior to the appointment time. These surveys will be sent to the patient/parent via text message through our check-in system. These surveys and questionnaires are designed to screen your child’s wellbeing and will allow the physician to spend more time addressing any issues that are important to you as the parent. THE PHYSICAN WILL NOT SEE YOUR CHILD UNLESS ALL SURVEYS ARE COMPLETED!
If you are having issues with our Phreesia check in system and/or are having issues electronically completing the surveys, we ask that you call our facility as soon as possible so we can give you further instructions. If the surveys are not completed by the time of appointment, we may ask you to reschedule your appointment.
Vaccination Policy
The field of Pediatrics, by nature, is concerned with preventative care. Realizing this, Pediatric Affiliates of Hampton Roads feels that despite our best efforts to educate parents about the effectiveness of vaccines and the realistic chances of vaccine-associated adverse events, some parents will decline to have their children vaccinated. Even though scientific data solidly supports the fact that vaccines are safe and effective, concerns over harmful side effects are often taken out of context in the media and on unmonitored and biased web sites. This causes substantial and often unrealistic fears. All parents and patients will always be informed about the risks and benefits of preventive and therapeutic procedures, including vaccination. In the case of vaccination, federal law mandates this discussion.
We will always provide parents (or guardians) with an opportunity to ask questions about their concerns regarding recommended childhood immunizations, attempting to understand the parent’s reason for refusing one or more vaccines, and maintaining a supportive relationship with the family. We consider this to be all part of a good risk management strategy.
If parents still refuse to vaccinate their child after a discussion has occurred with one of our providers, we will respect your wishes, but will unfortunately be unable to continue care as your child’s pediatrician. We follow all guidelines recommended by the American Academy of Pediatrics, the Virginia Department of Health, and all school systems which require all children to be up to date on their vaccination schedule.
Pediatric Affiliates participates with VFC (Vaccines for Children Program). This means our facility can provide low-cost vaccinations to under insured or Medicaid patients. If the patient is uninsured, we can provide vaccinations at an out-of-pocket cost of $21.24 per vaccine. Please be advised- if commercial vaccinations are administered to a patient and our facility discovers that the patient at the time did not have commercial insurance coverage, the patient will be fully responsible for the cost of the vaccination. If the practice draws up vaccinations for a patient and for whatever reason the vaccination is “wasted” (no longer able to be administered), the patient will be fully responsible for the cost of the vaccination. Examples of this could be:
- Agreeing to vaccines after counseling with the provider and then refusing the vaccine after vaccines were drawn
- Leaving your appointment prior to receiving the recommended vaccinations after vaccines have been drawn
If there is an emergency and the patient needs to leave our facility immediately, we ask that you please alert the clinical staff or provider as soon as possible to prevent vaccine wastage.
Minors and Consent to Health Care
It is our policy that all minors must be accompanied by a legal parent or guardian at the time of visit. The only exceptions to this policy are emancipated minors and minors who are seeking care under the following categories according to Virginia Code §54.1-2969:
- Health services to diagnose or treat venereal diseases
- Health services for birth control (except sterilization), pregnancy or family planning
- Health services for outpatient treatment or rehabilitation for substance abuse
- Health services for outpatient treatment or rehabilitation for mental illness
If a minor comes in unattended at the time of visit, we will ask you to reschedule your appointment.
Lab Policy
Pediatric Affiliates of Hampton Roads currently sends out labs drawn in-house to LabCorp or Sentara. Both facilities accept most health plans that our Practice participates with. However, there may be cases in which your individual plan does not participate with these lab facilities or lab procedures.
It is ultimately the guarantor’s responsibility to ensure (prior to having labs drawn within our practice) that your insurance participates with either of the labs that we use. It is impossible to know every specific insurance plan’s contracted/preferred lab. You may contact your insurance company, LabCorp or Sentara to find out if your specific plan is in network. If your plan is not in network with LabCorp or Sentara, or if the lab that was drawn on your child went towards your deductible or co-insurance, you will receive a bill from the lab. Bills received from the lab are NOT AFFILIATED with Pediatric Affiliates of Hampton Roads. If you believe that there is an issue with the bill from the lab, you must contact that facility and not Pediatric Affiliates of Hampton Roads to resolve these issues.
If you have any questions or concerns, please contact Pediatric Affiliates’ billing department.
Well Visits
As of September 26, 2010, The Affordable Care Act mandates that insurance covers preventative services (a.k.a “well visits” or “physicals”) 100%. This means that there is no costs to you, the parent/guardian, for the physical examination portion of the physician’s visit for a Preventative well care visit.
Initial ADHD Appointments
If it is suspected that your child may have ADHD, you will be encouraged to schedule an initial ADHD appointment. PRIOR to this appointment, one of our staff members will be in touch with you to discuss the process. We will send you a parent copy of the Vanderbilt questionnaire as well as a teacher copy of the Vanderbilt questionnaire for you to distribute to two or three of your child’s teachers. These teachers should be the ones whom your child is in close contact and has the most issues with.
Once the teachers have completed these forms, they must send these forms back to our facility either by their school email, faxed from the school to us at 757-389-8123, or in a sealed envelope mailed to our facility. The parents CAN NOT hand back or send the teacher’s copy to our facility. This is to allow the teacher to be honest and accurate, completing the questionnaire without bias. Parents can send the forms via mail, email to info@doc4kids.com, hand it in person, or fax over their forms to 757-389-8123. Once the parent and teacher copies of the Vanderbilt forms have been returned to us, one of the physicians will review the forms and determine if there is a need for an initial evaluation. If the doctor deems that it is necessary for the child to have an ADHD evaluation, one of our staff members will reach out to you to schedule the appointment. An initial ADHD evaluation WILL NOT BE SCHEDULED without going through this protocol.
ADHD Medications and Controlled Substances
Due to tightening governmental regulations, Pediatric Affiliates needs to implement a clear policy for medications used for the diagnosis of ADD/ADHD with refills prescribed by our physicians. The medications that are used for the treatment of ADD/ADHD are “controlled medications” and as such, there is a potential for abuse. In addition, it is imperative that our physicians monitor patients that take these prescriptions. Due to any potential audit by the Drug Enforcement Agency or the Board of Medicine or Pharmacy, it is necessary that we see your child for a medication evaluation EVERY 6 months (180 DAYS). During this evaluation, we assess your child’s response to, adverse effects from, and potential need to change dosing of the medications for ADHD. In addition, your child’s blood pressure, pulse, and weight will be measured, and a physician exam may be performed. We also require that your child receives and is current on their yearly wellness check. In order to receive monthly refills on your child’s medication, an appointment must already be scheduled for the 6-month medication recheck. This is a requirement for monthly refills- NO EXCEPTIONS.
Please note that we also require a 72-hour advance notice when requesting a refill. Requests for refills should be made Monday through Friday. By law, refills must be written on paper prescriptions or e-scripted by a physician. Paper prescriptions MUST be picked up in person and signed for by the parent, legal guardian, or authorized adult listed on your child’s listed in your child’s chart. These controlled medications cannot, by law, be called into a pharmacy.
Any changes needed in your child’s medication or to the strength of the current prescription may require an additional appointment for assessment. As such, if your child’s medication or strength is changed, a recheck appointment is reviewed within 4 weeks of the medication change.
Sports Physicals
Pediatric Affiliates of Hampton Roads offers sport physicals for patients. Sport physicals are not the same as a preventive physical/wellness visit as sport physicals focus on clearing a patient to play sports or participate in an activity. Each school, organization, etc. has its own criteria and policies for sport physicals- some facilities require the examination to be performed close to the start date of the sport or activity, others may accept a sport physical as long as it has been performed within 365 days. Because of the varying criteria, policies, and forms to be completed, we ask that you refer to the organization’s requirements PRIOR to scheduling a sport physical. We also ask that you provide us with the sport physical form to be completed at the beginning of the appointment. Our facility has a general sport physical form, but more often than not, the organization in which your child is playing a sport for will require their own particular form to be filled out by the physician.
Since a sport physical is used to clear a patient for an extracurricular activity, it is not viewed as medically necessary. This means that insurance WILL NOT COVER THIS SERVICE. Pediatric Affiliates charges $65.00 for this service and is due at the time of check-in. If you need a sport physical and it happens to align with the time your child is due for their wellness visit, Pediatric Affiliates can couple the sport physical with the wellness physical, and as a courtesy, we will not charge you for the sports physical. We ask that you inform us when scheduling the wellness visit AND inform the physician BEFORE the start of their examination that you would also like a sport physical. If the physician is not informed by the parent that they needed a sport physical and the sport examination is not performed, the physician WILL NOT be able to fill out the sports physical and you will have to schedule a separate visit for this service.
Prescription Refills
Please help us by anticipating the need for a refill and by giving us 48 to 72 business hours to process refills for your child’s prescription. We ask this because most refills require a review of the patient’s medical records. Please note that prescriptions for controlled substances such as Ritalin, Concerta or Adderall cannot be refilled by phone and require a written prescription. Prescriptions for controlled substances cannot be mailed and must be picked up at one of our offices.
The Responsible Party
A Guarantor is the person who is responsible for coordinating your child’s insurance information with us. This is the person we will contact regarding financial responsibility. Other adults may bring your child to a visit or carry health insurance for your child but only if identified as such by the Guarantor. If the child is from a divorced or separated family, we must have a copy of the legal separation or divorce decree which shows which parent has “medical custody” of the child. We also would need any other legal financial arrangement between the two parties as to who is responsible for payment for services. We will bill the appropriate insurance, but the Responsible Party is accountable for any balances remaining. If your child gets care from any other facility other than Pediatric Affiliates (e.g. lab, x-ray, hospital), you will receive a separate bill for those services from the lab or x-ray provider.
Insurance and Coordination of Benefits
It is ultimately the patient/parent’s responsibility to provide our facility with up-to-date, accurate, and valid insurance information. If there have been any changes to your insurance plan, we expect that our facility will be notified with the new information as soon as possible. If you have valid insurance, all claims will be sent to your insurance on file. Once we’ve received your claim remittance, you will be made aware of any patient responsibility by our facility sending a statement to the guarantor. If you have any questions regarding a patient balance, please call our Practice and we will direct you to our accounts department. After speaking with us, if you do not agree with the patient balance (i.e. the balance going towards your deductible, etc.), please call your insurance company- our facility has no control over your personal benefits and what insurance deems as patient responsibility.
Newborn Insurance
Most health insurances will have a period where the mother’s insurance will automatically cover medical services of a newborn for the first 30 days of life. Some insurances, such as Tricare, will cover the newborn under the Tricare sponsor up to 90 days of life. However, this is NOT the case for every insurance. Each insurance (both Medicaid and Commercial insurances) has their own terms and conditions for covering and adding a newborn to your insurance policy. We recommend that you call your insurance company as soon as possible if you have not already to inquire about their process for adding a newborn to your policy.
As a courtesy, Pediatric Affiliates of Hampton Roads (PAHR) will bill services rendered to the mother’s insurance for the first 30 days of life. If PAHR has not received valid insurance on the patient after 30 days of life, we will assume the patient is SELF-PAY and will collect at the time of service. If after collecting payment PAHR can verify that the newborn’s insurance was effective at the time of service, we will bill insurance and refund the parent/guardian.
We understand that welcoming a new baby into your family can be a wonderful but hectic time and we will do everything to assist you with insurance questions and issues. However, please remember that the parent/guardian is ULTIMATELY responsible for ANY balance not paid by insurance.
Past Due Balances and Payment Plans
On a monthly billing cycle, we send statements to your address for any outstanding balances due to us. We hope you will be prompt on your payment. Unfortunately, we have had to institute an 18% APR on any outstanding bill not paid within a statement period (30 days). Past-due accounts greater than 90-120 days are subject to third-party action and potential discharge from the practice. Any account sent to collections will accrue an additional 33-1/3% to cover our expenses.
Fees and Payments
We are sensitive to the fact that the healthcare insurance industry has made the cost of healthcare difficult for many families. We make sure that our fees are within the bounds of local usual, customary and reasonable fees. It is standard practice that payment is expected for all office visits provided by our Practice. For payment, we accept cash and check payments. We also accept VISA, MasterCard, Discover and American Express. Patients with no insurance, who pay in cash, will receive a 5% discount on their bill if they make full payment at the time of service.
Returned Checks
We have a $35.00 fee for any checks returned to us by your financial institution for any reason. If we get a returned check, the account will be labeled as “not eligible for a check payment” and we will only accept cash or credit card as payment from that point on.