Our Policies

1. Please use respectful behavior:

Our policy is to treat everyone who enters/calls our office with kindness and respect. We understand that sometimes situations occur that are stressful and upsetting. However, we have a zero-tolerance policy for parents/guardians/patients who use curse words, threatening, and/or vulgar language with our staff. If this occurs, your family will be dismissed from our practice.

2. Appointment wait times:

We strive to minimize any wait time; however, emergencies do occur and will take priority over a scheduled visit. We appreciate your understanding.

3. Sick Visit During Well Visit:

A "Well Visit" or "Well Check" does not require a co-payment under the Patient Protection and Affordable Care Act. For your convenience, your physician or provider may discuss or treat your child for a medical condition during your child's well visit. This saves you from having to make several trips to our office. As a result, a co-payment or deductible may be required by your insurance company if discussions beyond your child's preventative care occur.

4. Prescription refills:

Please allow up to 2 business days for routine refills. Some refills may take longer depending on pharmacy stock/availability and/or need for prior authorization. Please remember that refills can only be given to patients who have been seen within the last 3 months.

5. Clean office:

No food or drinks are allowed in the waiting room or the exam rooms. Please watch your children! Any damages or vandalism will result in an invoice for damages or dismissal from the practice.

We schedule appointments in such a way that your child can be properly checked-in, examined, and treated in a timely manner. Although this cannot always be done, we strive to accomplish this and have several policies in place to accommodate your family’s needs:

1. Appointment Confirmations:

As a courtesy, we will remind you of your upcoming appointments via phone/text message. If you do not confirm your appointment in at least one manner within 24 hours of your appointment, we will assume you are out of the country or unavailable and will automatically cancel your appointment. A “No show” fee of $40 may be added to your account. This fee must be paid before a new appointment is scheduled. 3 missed/no-shows will result in dismissal from the practice.

2. Late arrivals:

If you are over 20 minutes late for your appointment, we will do our best to accommodate. However, on certain days it may be necessary to reschedule your appointment.

3. Sibling Add Ons:

If you arrive with your child for a visit and request to add on a sibling, we count that as a walk-in. If the schedule does not allow appropriate time to properly care for your child, we will ask that you schedule the sibling later that day. All we ask is for a phone call ahead of time to let us know.

4. Walk-Ins:

We do not accept walk-ins. If a parent walks-in for a non-emergency visit, we will do our best to accommodate you and your child, however, you may be asked to return when there is availability. This allows our providers to spend the appropriate amount of time with you and your child.

We must emphasize that as pediatric providers, our relationship is with you, not your insurance company. While the filling of insurance claims is a courtesy that we extend to our patients, all charges are strictly your responsibility.

1. Insurance benefits / Coverage and Network:

It is the parent/guardian’s responsibility to understand which benefits are covered or not covered by their insurance program. The parent/guardian is fully responsible for all fees denied as non-covered services, as well as any deductibles, coinsurance, copayments, or other patient responsibilities, including charges incurred when services are out of network. It is also the patient’s responsibility to know their doctor’s network status, and we encourage checking with your insurance to avoid unnecessary charges. If we do not participate in your insurance plan, payment in full is expected at the time of the visit; however, we can provide an invoice that may be submitted to your insurance for possible reimbursement.

2. PCP designation

If you have an HMO insurance product, you are required to elect a Primary Care Provider (PCP). It is your responsibility to elect a provider with Fairway Children’s Medical Group prior to attending any visits to our office.

3. Self-pay:

Self-pay patients are expected to pay for services in FULL at the time of the visit. You must acknowledge that you have no insurance at the time of service.

4. Patient balances:

Billing statements are issued once we receive the Explanation of Benefits (EOB) from your insurance provider. Payment is due within 30 business days of the statement date. Any outstanding balance must be paid in full prior to scheduling or attending future appointments. Accounts with unpaid balances exceeding 90 days may be referred to an outside collection agency, and continued care with our practice may be discontinued.

5. Newborns:

Newborns are typically covered under their mother’s insurance plan for the first 30 days. You must enroll your baby for ongoing care. Any claims denied by the insurance company will be the responsibility of the parents / guardian.

6. Copays:

We are required by our insurance contracts to collect all co-payments at the time of service. The parent/guardian who brings the child at time of service will be responsible for the copay. A $10 service fee will be charged in addition to your co-payment if the co-payment is not paid by the end of that business day.

7. Medi-Cal:

If your child has Medi-Cal and is also covered under a private health insurance, we are required by law to file claims with the private insurance policy first. Medi-Cal plans are always considered as secondary insurance. If Medi-Cal is not informed that your child also has private insurance, they have the right to retract payment from previously paid claims. If this occurs, then the entire balance will be the responsibility of the parent/guardian on file.

8. No show fee:

We understand that unexpected situations may arise, so the fee for the first missed appointment (no-show) will be waived. A $40 fee may be charged for each additional missed appointment. Three or more no-shows may result in additional fees and possible dismissal from the practice.

9. Well Check plus sick visit:

A “Well Visit” or “Well Check” does not require a co-payment under the Patient Protection and Affordable Care Act. However, for your convenience, your physician or provider may discuss or treat additional medical concerns during your child’s visit to avoid the need for multiple appointments. If care is provided beyond preventive services, your insurance company may require a co-payment or deductible. This may include management of pre-existing or chronic conditions (such as constipation, ADHD, anxiety, depression, asthma, eczema, or allergies) or evaluation and treatment of new or acute concerns (such as fever, ear pain, sore throat, abdominal pain, cough, rashes requiring further work-up, wart removal, joint pain, or behavioral concerns). For questions about your specific coverage, benefits, or co-payments, please contact your insurance company directly, as coverage varies by plan, and our practice cannot determine individual insurance benefits.

Fairway Children’s Medical Group (FCMG) requires that a valid Credit Card be kept on file.

The policy is designed to:

 Help avoid all billing related fees.

 Streamline the billing process in our oƯice and eliminate the expenses related to handling overdue

accounts.

 Focus our time and energy on your children and their medical care.

The card information is stored electronically in an encrypted form and cannot be viewed by our office staff. Your signature will authorize the card to be used only when your balance becomes past due.

How the policy works:

1. At the time of your registration or check-in, you will be asked for your credit card information to be

electronically stored in encrypted form in our system. Only the last four digits are visible to our staff.

2. We will bill your insurance carrier as a courtesy for all charges related to the visit.

3. When we receive an explanation of benefits (EOB) from your insurance, we will send you a statement if

needed. If we have not received payment within 30 business days, we will charge the credit card on file

for the balance due (on the statement)

4. If we attempt to use your card and it is declined or has expired, we will send you a new statement with a

note attached asking for current credit card information.

Unless court documents state otherwise, our office will presume that parents share joint custody of their children and have equal rights to access medical records and make decisions about their care.

We understand that family changes like separation or divorce can be challenging. While we empathize, we focus solely on your child's medical needs. To best advocate for your child, we will remain impartial and not engage in parental disputes. Parents must communicate directly with each other regarding their child's care. Our office will not discuss legal issues or mediate disputes.

Our office follows all legal orders but requires official documentation to ensure compliance. Custody arrangements must be established through the courts or the Department of Children and Families.

COMMUNICATION:

We are not responsible for sharing visit information with each parent separately, and we will not contact the non-attending parent after visits. Either parent can access visit details with a signed medical release form. Appointment reminders will be sent to the primary phone number on file; this automated process cannot be customized by appointment or withheld at a parent's request.

APPOINTMENTS WITH PARENTS:

We accommodate appointment requests from either parent concerned about their child's health. However, appointments will not be scheduled solely for one parent to document their perspective. If this occurs, we reserve the right to deny future requests.

BILLING:

Our contract with your insurance provider requires that copays be collected at the time of service. Payment is expected from the attending parent, and a receipt can be provided. Accounts with unpaid copays will incur a late fee.

AUTHORIZED ADULTS:

Either parent may authorize a non-parent, such as a stepparent, grandparent, or partner, to accompany their child to an appointment. Without legal documentation stating otherwise, we cannot restrict an authorized adult from attending. The parents are responsible for coordinating who is authorized to accompany the child.

DISPUTES:

Our providers and staff will not mediate or participate in disputes between parents. If disagreements interfere with care or disrupt our office, we reserve the right to discharge your family from our practice.

We encourage parents to prioritize their child's well-being. These situations are difficult, but cooperation is essential to support your child's health and emotional needs. Our shared priority is ensuring your child receives the care they deserve.