Patient Information

A fully completed, current patient registration will be on file with your medical records as long as you are considered an active patient of Lawrence Family Care and Pediatrics. We ask that you update your patient registration yearly and include where we may reach you by phone. A signature by the responsible party is required. Insurance ID cards must be presented at every visit.

Insurance Claims

Lawrence Family Care and Pediatrics will file claims upon submission of insurance information. Your insurance card must indicate coverage, id number, group number, and a claims mailing address. If you have insurance coverage but cannot provide documentation, payment is due at the time of service.

Secondary insurance will be filed if it is a supplement to Medicare or if we are contracted with that insurance company. However, if payment is not received in our office within 45 days after filing, the responsibility will be transferred to the patient and due upon receipt.

Patient Financial Responsibility

If insurance is not to be filed by Lawrence Family Care and Pediatrics or if our doctors are not participating providers, payment is due at the time of service. Co-deductibles, co-insurance, and non-covered services are also due at the time of service.

Minor/Dependents

Children under the age of 18 will require the signature of their parent or legal guardian on the registration form. We must have authorization to treat an unaccompanied minor.

Worker’s Compensation and Motor Vehicle Accidents

Payment for visits related to worker’s compensation and auto accidents will be due at the time of service.

Payment

VISA, MasterCard, and debit payments are accepted by phone or mail. There will a $25.00 charge for any returned check.

Accounts Past Due

Payment from statement is due upon receipt. Only two statements will be sent to patients with past due balances. If we receive no response to these statements, a letter will be sent to the patient. This letter will allow the patient 30 days to pay the balance or make payment arrangements.

Non-compliance may result in preparation of the account to an outside collection agency and patient discharge from the practice. In the event an account is turned over for collections, the person financially responsible for the account will be responsible for all collection costs, including reasonable attorney fees and court costs. When an account is turned over, medical services in this practice will be terminated.

Missed Appointments

Lawrence Family Care and Pediatrics requires at least 24 hours notice of appointment cancellation. Missed and non-previously cancelled appointments will be charged a no show fee of $25.00 for a 15-minute appointment and $50.00 for any appointments scheduled for more than 15 minutes. Fees incurred as a result of a missed appointment or an appointment not cancelled within 24 hours of the scheduled time will be billed to the patient. After three no show appointments, the patient will be dismissed from the practice.

Account Consultation

Physicians and clinical staff do not discuss financial issues. Our front office and billing staff is trained to discuss your account and make payment arrangements and will be happy to help you. However, if you need further assistance, please consult our Practice Manager.

Medical Records

If you require us to transfer your records to another primary care physician, we are required by law to receive a signature prior to releasing the records. The fee for this service is $20.00 for the first 10 pages and 25 cents per page thereafter.