We participate with most PPO and some HMO plans. Please call our office for the most recent list of accepted insurances. Please familiarize yourself with your insurance policy. We will verify specific benefits upon request; however it is your responsibility to know your benefit plan.


Insurance Claims

We will submit your insurance claims based on the information you give us. In some cases the insurance company may request certain information from you directly. It is your responsibility to follow through on any request made of you from the insurance company. Please be aware that your insurance benefits are a contract between you and your insurance company; any remaining balance is your responsibility.


Non-covered services

If any services are not covered under your plan, you are responsible for payment.



We send out billing statements every month. After 90 days, we will send a final notice. We must receive payment within 10 days or you must call our office to make payment arrangements. If your account remains delinquent, you may be referred to a collection agency and you may be discharged from the practice. We will then give you 30 days to find a new doctor.



All co-payments, deductibles, and co-insurance must be paid on the day of your visit prior to services being rendered. This is part of the contract with your insurance, and we are required to comply with these terms.


Proof of Insurance Coverage

We require a copy of your current insurance card every month. In addition, a Patient Verification Form must be signed at every visit to ensure we have your most updated billing information, address, and phone number. By signing this form you authorize direct payment to the treating physician and understand that any services not covered by your insurance will be your responsibility.


If you have no insurance card at the time of service and we cannot verify an active insurance policy, you will be required to pay in full prior to leaving the office.


Change of Coverage

If your insurance policy changes, it is your responsibility to provide us with the new insurance information, including a copy of your new card. If you fail to submit this information to us in a timely manner you may be responsible for any balance due.


Double Coverage

If there are two insurance policies, we bill according to the date of birth rule: the subscriber (guarantor/parent) whose birthday month and day is earliest in the year will be considered the primary insurance carrier. We will collect the co-pay as dictated by this policy.


HMO Referrals

If you are an HMO member, it is your responsibility to obtain any necessary referrals prior to seeing a specialist. You must give us five business days to obtain a referral for you. If you seek treatment without obtaining a referral, you will be responsible for the balance for that visit.


HMO Hospital coverage

If you are an HMO member it is your responsibility to know which participating hospital to go to if your child has an emergency. Please contact your physician or the physician on-call prior to going to the emergency room.


If you are experiencing a life-threatening emergency please call 911 and you will be taken to the closest hospital. It is your responsibility to call the office the next day to request a referral for hospital services.


HMO Primary Care Physician

If you present an HMO card and a doctor here is not listed as your Primary Care Physician, you will be responsible for payment for any services rendered.


Missed Appointments/Cancellation Policy

If you miss an appointment or fail to give us 24-hour cancellation notice a fee will be charged directly to you.


Guarantor Policy

The parent/guardian who authorizes treatment of a minor patient and signs the registration forms as the guarantor will be held responsible for the costs associated with the medical treatment of the patient. The parent/guardian shall remain the responsible party until the appropriate forms are signed by the parent/guardian and the patient (non-minor) and the forms are received by our office. These forms cannot retroactively change the responsible party for charges that have already been incurred but will be documented for any future expenses. This policy will remain in effect after the patient is no longer a minor.


Late Policy

Our office reserves the right to refuse services to our patients if they arrive 10+ minutes late for their appointment.


Medical/School/Camp Forms

If you need a form to be filed out by the physician please present it at the time of your visit. If you forget the form and request it to be completed any time after the appointment, an appropriate fee will be applied.


Medical Records Fee

If you need a copy of your child’s medical records, there will be a $35 fee per child. Please keep in mind that our office requires adequate time to prepare your records, so submit your request as early as possible.

If you are transferring into Northside Suburban Pediatric Associates, please bring us a copy of your child’s medical records.


Walk-In Policy

Walk-in services are available daily during certain business hours. Please refer to our Hours page for more information.


Well Visits

Some insurance companies limit how many "Well Visits" a patient is allowed per year. Please check with your insurance provider or call our office if you need assistance.


Please feel free to ask us any questions you may have about these policies.  Click HERE to contact us.



© Copyright 2012 The Northside Suburban Pediatrics Advantage