Office Policies, Statements, and Guidelines
Thank you for choosing Sunshine Pediatrics of Florida to care for you and your child. It is our
desire to provide you with the best care possible. Below are several office policies, statements,
and documents that you need to be aware of and acknowledge for us to better serve you.
Please acknowledge or sign at the bottom. Following are included:
- Financial Policy
- Drug screening and In House labs Policy
- Vaccine Refusal Policy
- Adverse Event Acknowledgement
- Photo/Video Consent Policy
- Etiquette Policy
- COVID Mask Policy
- Awareness of NOTICE OF PRIVACY PRACTICES
✓ Our billing policies and list of potential fees and charges are outlined below. This
information is to ensure you are better informed at the time of service and prior to the arrival of a billing statement.
- As part of your contract with your insurance company, payment is due at the time of service.
- This will include any copay, deductible, or any out of pocket charges per your insurance plan. Charges will vary per the type of insurance plan.
- For deductible only plans- The office visit charge will be collected at check-in.
- If payment is not collected for whatever reason (i.e. human error, system down), you will still be responsible for paying
- We will file your claim with your insurance company as a courtesy to you.
- You will be responsible for all charges incurred at Sunshine Pediatrics of Florida. If your claim is not paid by your insurance company within a reasonable period, you will be responsible for payment.
- It is your responsibility to keep us updated with your correct insurance information.
- It is critical that the most current insurance ID card is brought to every appointment.
- You must select an active provider of Sunshine Pediatrics of Florida as the primary care provider with your insurance company, prior to any Office or Televisit. If we are not the assigned provider prior to the visit, Nirmala Inc DBA as Sunshine Pediatrics of Florida reserves the right not to see the patient for that visit
- Newborns must be added to your policy as soon as possible
- Most insurance companies require they be added within thirty (30) days after the baby is born.
- All health plans are not the same and do not cover the same services.
- In the event your health plan deems a service to be “not-covered” you will be responsible for the charges. Payment is due upon receipt of an e-statement from our office. It is the patient or Parent/Guardian’s responsibility to periodically check their patient portal access for E-statement. We will attempt to either mail, email or text notify of payment due.
- Well appointments
- According to children’s age, there is a CHADIS survey that will be required for your child to complete. They are a necessary part of the visit and are a standard of care. The survey must be billed and charged under individual billing codes separate from the well visit code. If these services are not covered, you will be responsible for payment
- Not all plans cover well visits, vision/hearing screenings, and other services provided by us that are recommended by the American Academy of Pediatrics and are a standard of care. If these services are not covered, you will be responsible for payment.
- If your insurance company allows a certain number of visits per year and those visits have been maxed, you will be responsible for payment.
- Combined Visits
- If you are scheduled for a well-child exam, and other health concerns are brought up that would typically require a sick visit, your insurance may consider these two separate visits and bill your copay and other charges accordingly. You will be responsible for these payments.
- After Hours/Urgent Surcharge
- Our extended hours are provided as a courtesy to our patients to avoid a costly visit to an ER or urgent care facility
- We may bill your insurance additional codes (99051 or 99058) for services provided out of routine office hours (after 5pm on weekdays and any visits for Saturdays & Sundays), and for same day appointments, walk-in appointments and urgent visits.
- Self Pay Patients
- Payment needs to occur prior to beginning of the visit. If there are any In House tests or procedures done in office, they will be an additional cost that is patient responsibility. We would prefer that you pay that fee prior to leaving the office visit.
- Administrative Fees:
- No-Show fee – We reserve the right to dismiss you if there are repeated no shows or we will assess a no show fee if you do not show up for a scheduled appointment at $25.00 per NO SHOW
- Fees for Returned check for insufficient funds $50.00
Drug Screening and In House Labs Policy
✓ This policy applies to all patients of Sunshine Pediatrics of Florida.
✓ It is the policy of Sunshine Pediatrics of Florida to order or send urine out for drug toxicology on a random basis for patients with certain diagnoses.
✓ It is the policy of Sunshine Pediatrics of Florida to do In House tests available to us to aid in either diagnosing or managing our patients
Vaccine Refusal Policy
✓ Purpose: Sunshine Pediatrics of Florida is committed to quality care to our patients. In order to continue to provide ongoing care and be compliant with the Agency for Health Care
✓ Administration, as of January 1st, 2020, it is our office policy to no longer accept patients in our practice who desire not to vaccinate or have a modified vaccine schedule. Patients who were enrolled in our practice prior to this date and have either exemptions or modified vaccine schedules will need to maintain compliance with meeting their HEDIS care gaps to continue with our practice
✓ Scope: This policy applies to all patients of Sunshine Pediatrics of Florida that are not up to date with, or those who refuse or are on delayed vaccines schedules
Adverse Event Acknowledgement
✓ We are happy to support your healthy lifestyle. We are not responsible for adverse events/death due to over the counter medication, herbal supplements, Vaccine refusal, delayed Vaccine schedule or any natural or herbal supplement written by us upon your request.
You, as a patient or parent or guardian fully understand the consequences of medications, supplements, vaccine refusal and delayed vaccine schedules and any such treatments, not limited to ones mentioned. Also, this includes responsibility for written treatments that are not formally prescribed by the practitioners of Sunshine Pediatrics of Florida and has been written upon my request. I take full responsibility for adverse events/death that may occur due to my own decision.
Photo/Video Consent Policy
✓ I give my consent to Sunshine Pediatrics of Florida to take and use photos/videos or written testimonials for publicity purposes; on Sunshine Pediatrics website, brochures, flyers, news releases and in presentations to future prospective parents and patients. I understand that I will not receive any compensation for such uses. I retain the right to have any photographs discontinued from use in any or all of the above venues upon request. If, at any time, I wish my photograph(s) to be discontinued from any of the above, it is my responsibility to contact the office of Sunshine Pediatrics to make this a written request.
- I will not bring any food or drinks past the waiting room door for myself or any family member accompanying me for the appointment
- I will utilize the Well and Sick waiting areas for the exact purpose for what they were designated for.
- I will make it to the appointment on time and be kind when inquiring about my wait time or any other concerns with the staff
- I will communicate and express my concerns with the Staff and Physicians at Sunshine Pediatrics of Florida in a professional and courteous manner. I will utilize Patient Portal to the utmost of my abilities for this purpose.
COVID Mask Policy
✓ Our top priority is the health and safety of our staff, patients and community. In an effort to best protect our staff and patient’s health we are requiring all staff members to wear masks while in the office. Due to the low risk exposure rate in our community, as per CDC guidelines we are only recommended mask usage for our patients and family members over the age of 4 while in the clinic. This can be subject to change depending on CDC recommendations. Sunshine Pediatrics of Florida will continue to follow health and safety guidelines recommended by the CDC and other leading medical authorities.
Awareness Of Notice Of Privacy Practices & Rights And Responsibilities
✓ I am aware that a Notice of Privacy Practices is posted on the waiting room Bulletin Board to which I have access to. I have read and acknowledged with an understanding of the content in that document. I am aware that I can request a copy of this document if I desire.
✓ I have read all the above Policies, statements, and guidelines and agree with all of them as written to its entirety. I agree that I have a complete understanding of the content in the above documents. I agree to all the responsibilities assigned and meant for me and will comply. I agree and am aware of the posting location of NOTICE OF PRIVACY PRACTICES.