Policies & Forms • Medical Center Pediatrics

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Forms &
Downloads Insurance
& Billing Office
Policies After-Hours
Care Vaccination Policy

Patient Forms & Downloads

For new patient registration forms, please contact our office.

Policy Documents

Financial Policy
Vaccine Policy
Notice of Privacy Practices
Adolescent LetterImportant Information for Parents of Adolescent Patients

Specialist Referrals

Pediatric Specialty Providers
Mental Health Providers
Therapy ServicesPT, OT, Speech Therapy, Lactation and More

Insurance & Billing

Our main focus is to provide first class medical care to our patients. In order to do this, we must receive prompt payment. Our financial policy has been developed:

To meet our financial obligations
To follow terms set by insurance contracts
To help you understand your financial responsibilities for the services we provide

If you have any questions concerning these policies, please contact our office.

Read Our Financial Policy Pay Your Bill

Your Responsibilities

To know the limits and coverage of your health insurance policy.
To ensure that one of the doctors at Medical Center Pediatrics is assigned as your primary care physician, if required by your insurance policy.
To pay any copayments or deductibles at the time of service.
To show your child’s current insurance card and your photo ID at each visit.
To provide updated address, phone numbers, and insurance information to our office.

Accepted Insurance

We accept the following insurance providers, as well as many smaller plans not listed here. Please contact us with any questions.
Aetna
Blue Care Network
Blue Cross
Blue Cross Complete HMO
Cigna
HAP
Medicaid
Meridian HMO
Meritain
Molina HMO
Priority Health
Tricare East
United Healthcare
United Healthcare Community Plan
UMR

Responsible Party

The parent/guardian who accompanies the child to the appointment is responsible for the payment that day. There will be a $5 statement fee if the responsible party fails to pay their copay or bill on the day of service. In cases of separation or divorce, both parents are responsible for any balances.

Newborns

We realize that it may take some time for newborns to be added to an insurance policy. However, it is very important that you provide the insurance company with the information that they request in a timely manner. Failure to do so may result in delays of coverage and greater financial costs to you.

Account Balances

If you have a deductible, coinsurance, or non-covered service, you will receive a bill in the mail. Payment within 30 days is appreciated. After 60 days, your account will be assessed a $25 fee for non-payment. After 90 days, we reserve the right to postpone treatment and also to dismiss your child from the practice for non-payment. We accept cash, personal checks, Visa, MasterCard, American Express, Discover, Debit Cards and Health Savings Account Cards. If your bill is sent to collections, you will be responsible for all charges incurred in this process. If there are financial hardships, we are happy to discuss payment plans.

Additional Services & Claims

During routine well visits, we take the time to address all aspects of your child’s health. If additional medical concerns are discussed or managed during these appointments, we may bill your insurance for these extra services alongside the standard wellness exam.

Please be aware that this may result in co-pays, co-insurance, or charges applied toward any unmet deductibles, depending on your insurance plan. We encourage you to review your insurance benefits to understand your coverage fully.

Our commitment is to provide comprehensive care that supports your child’s growth and development. We appreciate your understanding and are always here to answer any questions you may have about our services or billing practices.

Uninsured Patients

We are happy to work with families that do not have insurance. Please request further information on our self-pay discounts.

Returned Checks

All returned checks are assessed a $25 service fee, which is not billable to your insurance.

Office & Appointment Policies

Appointments Are Required

We offer walk-in sick visits on weekday mornings at our Bingham Farms location. Otherwise, patients are seen by appointment only, so please call ahead even if you feel your child needs to be seen right away. We will make every effort to see sick patients on a same-day basis. Well child visits should be scheduled in advance.

Please call our office to schedule your child’s appointment anytime during our normal business hours.

Calls During Office Hours

We encourage you to call the office with your questions. Our billing department is available from 8:30 am to 4 pm, Monday through Friday. For medical questions, call us from 8:30 am to 4:30 pm, Monday through Friday, and 8:30 am to Noon (office may close early) Saturdays and Sundays (Bingham Farms location only). You can talk to a nurse or leave a message for your primary care doctor. When you leave a message during office hours, we will do our best to get back with you as quickly as possible.

Please note that we bill your insurance for doctor calls exceeding 5 minutes per day or nurse-only calls exceeding 15 minutes. Brief calls taking less than these thresholds are complimentary. Whether you have an out-of-pocket cost is determined by your insurance plan and policy.

Telehealth Visits

For your convenience, we offer telehealth visits for acute illnesses or chronic conditions for which we feel it is safe to provide care using virtual technology. These include colds, pink eye, rashes, vomiting, diarrhea, constipation, minor injuries, breastfeeding concerns, ADD/ADHD, behavioral issues, anxiety, and depression.

Visits need to be scheduled with our front desk.
Ask your insurance if your plan covers virtual or telehealth visits. If the visit is not a covered benefit by your insurance, then the visit charge will be passed onto you for payment.

Mutual Respect of Time

We strive to stay on schedule. Although there can be emergency situations that prevent us from running on time, we pledge to provide quality care with minimal wait time to the best of our ability.

Please be considerate and call us before your appointment if you are not able to attend or if you are running late. Missed appointments represent a cost to us, you, and to other patients that could have been seen during the time set aside for your child. You may be asked to reschedule if you are late for your appointment.
Cancellations are required 24 hours prior to an appointment.
Any appointment cancelled less than 24 hours in advance may be marked as a No Show. A $50 fee will be charged to your account.
If you have 3 no-show appointments, you will be dismissed from the practice.

Medical Records

Should you require a copy of your child’s medical record, you may obtain it from the patient portal at no charge to you. Requests for MCP to copy records will be assessed a $25 fee.

You will be required to complete a medical record release form (available on our website). Please contact the Practice Manager for special requests. Once payment for records is received, please allow 15-30 days to complete.

Medication Refills

Refills must be requested through your patient portal. To make a request within the portal:

Login to the Patient Portal
Choose child in upper right corner
Click on “Request a refill”

If you need assistance with accessing your portal, please contact the office.

After-Hours Care

If your child’s illness or injury is life threatening, dial 911.

Otherwise, for urgent matters that cannot wait until business hours, please call our answering service at 248-691-8614, and the doctor on call will contact you as soon as possible. While you are waiting for the doctor to return your call, please deactivate any call-blocking features on your phone. For privacy purposes, our doctors block their numbers.

Poison Control Hotline
(800) 222-1222

Suicide & Crisis Lifeline
Dial/Text/Chat 988
www.988lifeline.org

Health Education Tools

Symptom CheckerUse this symptom checker to learn how serious your child’s symptoms are, whether you need to see the doctor, and how you can provide relief.
Dosage CalculatorBe confident that you are treating your child with the correct dose of Tylenol or Motrin.
First AidValuable step-by-step guidance for everything from a sprained ankle to a lost tooth.
Parent AdviceHelpful advice on dozens of topics, from sleep and toilet training to behavior and nutrition.
Health & Wellness WebsitesOur recommendations for accurate online resources you can trust.

Urgent Care

Corewell Health Beaumont Troy Hospital Children’s After-Hours
44201 Dequindre Road Suite 502
Troy, MI 48085
248.964.5880

Mon–Fri: 6pm–10pm
Sat-Sun: 11am–9pm

Michigan Orthopedic Surgeons
30575 Woodward Avenue
Royal Oak, MI 48073
248- 280-8550

Mon–Fri: 5pm–9pm
Sat–Sun: 10am–2pm

Hospitals

Our doctors are on staff at:

Corewell Health William Beaumont University Hospital
3601 W. 13 Mile Road
Royal Oak, MI 48073
248-898-5000

Children’s Hospital of Michigan
350 West Big Beaver Rd
Troy, MI 48084
(248) 524-7180

Henry Ford West Bloomfield Hospital
6777 W Maple Road
West Bloomfield, MI 48322
248-325-1000

We also recommend:

C.S. Mott Children’s Hospital
1540 E. Hospital Dr.
Ann Arbor, MI 48109.
734-936-4000

We Are a Vaccinating Practice

We firmly believe that vaccinating children and young adults may be the single most important health-promoting intervention that we perform as healthcare providers and that you can provide as parents/caregivers. The recommended vaccines and vaccine schedule are the results of years and years of scientific study and data gathering on millions of children by thousands of our brightest scientists and physicians.

Because we are committed to protecting the health of your children through vaccination, we require all of our patients to be vaccinated on time. If your child is behind on vaccines at their time of transfer to our practice, we will begin a catch-up schedule to ensure that your child is brought up to date regarding current vaccines for age. If you choose to separate vaccines during the catch-up phase, they are to be scheduled a minimum of 2 weeks apart until the child is up to date.

If you should refuse to completely vaccinate your child, we will ask you to find another healthcare provider who shares your views. Please recognize that by not vaccinating, you are putting your child at unnecessary risk for life-threatening illness and disability, and even death.

We are committed to providing the safest environment possible for families who do choose to seek care here, and fully support evidence-based medicine. As medical professionals, we feel very strongly that vaccinating your child on schedule with currently available vaccines is absolutely the right thing to do to protect all children and young adults.

Resources

Immunization ScheduleAmerican Academy of Pediatrics (AAP)
Vaccine Information Statements
Vaccine Education CenterChildren's Hospital of Philadelphia
Vaccine Safety: The FactsAmerican Academy of Pediatrics
VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
Immunize.orgFormerly Immunization Action Coalition (IAC)