NEW PATIENT FORMS
BILLING & INSURANCE
We are doing everything possible to hold down the cost of medical care, and we agree to provide quality medical care at a fair and reasonable price. You can help a great deal by eliminating the need for us to bill you and by understanding the benefits of your insurance. The following is a summary of our payment policy.
PAYMENT IS EXPECTED AT TIME OF SERVICE:
Payment is required at the time services are rendered, unless other arrangements have been made in advance. This includes applicable co-insurance, co-payments and outstanding account balances. Reston Pediatrics Associates Physicians accept cash, personal checks, and VISA, MasterCard, American Express and Discover cards. There is a service charge for all returned checks.
If you receive more than one type of service on the same day, you may be responsible for more than one co-pay or the balance for the additional service, depending on your insurance plan (i.e.: well exam and a routine/ sick visit). Any amount not covered by the insured/ patients insurance is due upon receipt of the bill. Failure to pay balances may result in discharge from the practice.
Patients with an outstanding balance of $100 or are 45 days overdue must make arrangements for payment prior to scheduling appointments.
MEDICAID PATIENTS We are not contracted with Medicaid and CANNOT see patients that have Medicaid. If you have Medicaid or plan to apply for Medicaid, you will need to find a provider that accepts Medicaid insurance.
We will give you an estimate of the cost of the visit and payment is due at the time of service. Please see the Front Desk staff when checking out.
Our billing representatives are available to discuss payment arrangements with you,
Monday-Friday between 8.00am and 4.00 pm, at 703-450-8660, ext 2001.
WE LOOK FORWARD TO MEETING YOU
VISIT US AT OUR NEW LOCATION
GET IN TOUCH WITH US TODAY
Please call or email us to schedule your meet & greet!
This form is for NON-MEDICAL communications only! If you have a question regarding your medical care, please call our office.
IF THIS IS AN EMERGENCY, PLEASE CALL 911 IMMEDIATELY!