Mia Bella Pediatrics Billing Policies


All co-payments are expected at time of service. For your convenience, Mia Bella Pediatrics accepts cash, personal checks, and Visa/MasterCard debit and credit cards. Surcharges will be assessed for returned checks or co-payments not made at time of service.
 
Our contracts with insurance companies require that we verify your current coverage and collect your co-payment at each visit. If your insurance plan requires deductibles and coinsurance, you will be asked to leave a credit card on file so we can charge the assessed patient responsibility after your payer returns the Explanation of Benefits. We do not store credit card numbers in our office, but we use a secure link to access the information when we need to process a charge. Please bring your insurance card to every appointment.

 
Download our payments and billing policy.
 

Fees for Non-Covered Services

 
The following fees will be charges for services that are not covered by insurance:
 

 
Missed sick child visit
(if not cancelled 2 hours prior)

 
 
$30
 
 
Missed well child visit
(is not cancelled 24 hours prior)

 
 
$50
 
 
Missed teen/concussion/nutrition appointment
(if not cancelled 24 hours prior)

 
 
$75
 
 
Returned check

 
 
$25
 
 
Co-payment not paid at time of service

 
 
$20
 
 
School/sports/daycare/camp form
(waived if presented at time of well visit)

 
 
$10
 
 
“Rush” (same-day) school/camp form
(waived if presented at time of well visit)

 
 
$30
 
 
Transfer records out
 
$15 per patient
$30 max per family
 

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