For the most up-to-date information on our accepted private health insurance plans call us directly. We accept most major insurance plans including:
- Blue Cross/Blue Shield
- Southern Health
- United Healthcare
- Virginia Health Network
Forms & Fees
All forms not brought in at the time of your child’s appointment will require a processing time of 5-10 business days and will be charged the following administrative fee/
- School/ Camp/ Sports: $10.00
- Pre-Op Forms: $10.00
- Dominion VA Power Forms: $10.00
- FMLA Forms: $25.00
We reserve the right to charge $25 for missed appointments. Please help us serve you better by keeping your scheduled appointments.
Important Network Announcements
There has been a change to our network affecting all Tricare patients, effective 6/29/2017. TRICARE PATIENT CLICK HERE
UNITED HEALTHCARE PATIENTS
We have heard from our United Healthcare patients that letters from UHC went out stating we will be out of network as of 6/29/2017. This is not accurate, and United Healthcare has reassured us that there will be no interruptions to our participating network status, and no gaps in care or coverage for our United Healthcare patients. Please call our office directly if you have additional questions or need clarification.
The legal guardian accompanying a patient to the first visit will be responsible for signing our financial policy as the guarantor. Payment is expected at the time of service, and in the case of estranged or divorced parents, the parent accompanying the child to the visit is responsible for any co-payments, co-insurance, or self-pay balances due at the time of the appointment.
Patient statements will only be sent to the address of the guarantor that signed and agreed to our financial policy. Chesterfield pediatrics will not intervene in any financial responsibility disputes between parents or other parties, and we will not look to anyone other than the guarantor to fulfill financial responsibility.
Returned Checks and Collection Fees
There will be a $35 returned check fee on all returned checks. In the event that your account is turned over to a collection agency, you will be responsible for all collection costs including reasonable attorney’s fees, whether or not the attorney files suit. Additionally, you will be assessed a finance charge of 1.5% per month on balances over thirty (30) days past due, which is an APR of 18%.
Payment for Services All co-payments are due at the time of service. Coinsurance and deductible balances will be billed and are due upon receipt. It is your responsibility to notify us of any changes in your policy information. Your insurance policy is a contract between you and your insurance company. Please be aware that some, and perhaps all, of the services we provide may be non-covered and/or not considered reasonable and necessary under your medical plan; we are not responsible for knowing what is covered and non-covered by your individual insurance plan. Additionally, it is your responsibility to obtain and track referrals and/or prior authorizations required for your care.