Financial Policy

We are currently taking Aetna, Healthsmart , United Healthcare , Monarch/Optum, Multiplan/PHCS, Beech Street and Cigna and soon will start taking Anthem BC, Blue Shield, First health, Health Net, Interplan, Humana,Pacificare, Medi-cal, and CHOC. Until we are contracted with the mentioned insurances we will be considered “out of network”. At the end of each visit, you will receive an itemized receipt (“superbill”) that you may submit to your insurance plan for reimbursement based on your out-of-network coverage. Although we cannot guarantee any specific reimbursement rate, many of our patients receive significant reimbursement of 50-80% of the amount we charge (after any applicable deductible has been met).We will be considered “out of network”. At the end of each visit, you will receive an itemized receipt (“superbill”) that you may submit to your insurance plan for reimbursement based on your out-of-network coverage. Although we cannot guarantee any specific reimbursement rate, many of our patients receive significant reimbursement of 50-80% of the amount we charge (after any applicable deductible has been met).

Payment and Pricing For Self-Pay Patients

INTRODUCTORY Unlimited Plans
Unlimited face-to-face visits Plan for $50 per month for a 12 month period. This plan includes 50% discount on telemedicine visits.
Unlimited telemedicine visits Plan for $50 per month for a 12 month period. This plan includes 1 face-to-face well visit exam.

Payment in full for all charges is expected on the day of your visit. Our basic charges are listed below. A complete list of prices for various procedures and testing is available in our office, and can be requested by calling us. For payment, we accept cash, and credit card.

Office Visit Types

  • Well Visit Exam(face-to-face) (45-60 minutes) — $150
  • Standard Office Visit(face-to-face)(15-30 minutes) — $125
  • Initial Counseling Visit for attention/behavior(face-to-face) (45-60 minutes) — $150
  • Telemedicine visit (15 minutes) — $50

Common Diagnostic and Lab Tests (performed in the office)

  • Audiometry — $35
  • Visual acuity test — $15
  • Hemoglobin — $25
  • Glucose — $15
  • Tuberculosis (TB) skin test (PPD) — $45 for placement and reading
  • Urinalysis — Clean catch $15, Collection bag $25, Catheter collection $100
  • Rapid Strep Throat test — $20
  • Rapid Flu — $40

DEDUCTIBLES, CO-PAYMENTS AND COINSURANCE:

IAll applicable copays, coinsurance and deductible amounts are due and expected at the time of service. If a deductible is applicable, ROYALKIDS CLINIC will collect $100 as an estimated amount for the office visit. Any remaining balance will be billed to the guarantor. If your plan has a coinsurance amount for Preventive visits, an estimated patient responsibility amount will be due at the time of service. For payment, we accept cash and credit card.

COVERAGE TERMS:

Your insurance policy is a contract agreement between you and your insurance company. You are responsible for knowing the terms and conditions of your policy. It is not the responsibility of ROYALKIDS CLINIC to know your policy details. As a courtesy ROYALKIDS CLINIC will attempt to verify eligibility and benefits, however, we are unable to obtain the exact details of payment until the claim is processed.

OUTSTANDING BALANCES:

Outstanding balances for all family members are due prior to the physicians visit. ROYALKIDS CLINIC has the right to refuse service for non- urgent medical services if balances are not paid in full before the scheduled visit.

INSURANCE UPDATES:

You are a responsible for providing us any updates to your insurance. If any charges are denied due to not providing current insurance information, the guarantor will be responsible for any unpaid balances.

BILLING POLICY:

As a courtesy, ROYALKIDS CLINIC will bill your insurance for all procedures performed at the time of service. When the Explanation of Benefits and insurance payment is received, your account will be credited. Any remaining patient responsibility will be expected when you receive a statement or at the time of your next appointment (whichever comes first).

INSURANCE COMPANY DISPUTES:

It is the plan holders' responsibility to negotiate payments with his/her insurance company. Remember, ROYALKIDS CLINIC bills your insurance company as a courtesy to you.

PPO's and HMO's:

We will do our best to verify your plan is in network with ROYALKIDS CLINIC, but it is ultimately the plan subscriber's responsibility to confirm their benefits and in network providers.

NO SHOWS AND CANCELLATIONS:

If an appointment is missed or is not cancelled 24 hours in advance a $50 fee will be applied to the patient!s account. This fee is not covered by insurance and therefore will not be billed to insurance. Child must arrive 15 minutes before check-in time. If arrival is after his/her check-in time family may be asked to reschedule the appointment.

COPY OF MEDICAL RECORDS:

A written request must be received prior to the release of each medical record. ROYALKIDS CLINIC charges a reasonable clerical fee of $20.00 for each patient's medical records. We have 14 days from time of written request and payment in full to provide the records.

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