Legacy Pediatrics

1815 S. Clinton Avenue
Rochester, NY 14618
Tel: 585-568-8330
Fax: 585-568-8327
info@legacypediatrics.com

Payment Policy

Legacy Pediatrics does everything possible to minimize the cost of medical care. You can help a great deal by eliminating the need for us to bill you. The following is a summary of our payment policy.

Payment is expected at the time of service

Payment is required at the time services are rendered unless other arrangements have been made in advance. This includes applicable co-insurance and co-payments for participating insurance companies. Legacy Pediatrics accepts cash, personal checks, visa, and master card. There is a service charge of $25.00 for returned checks.

Outstanding Balance

A $25.00 service fee will be added to all bills that have an outstanding balance of 90 days overdue. We realize that people have financial difficulties. Please communicate with our billing and collection staff so that they may assist to create a financial plan with you. Accounts that are referred to a collection agency may no longer be patients in our practice.

Insurance

We bill participating insurance companies as a courtesy to you. You are expected to pay your co-pay at the time of service. Deductible plans are billed to the insurance company then any remaining balance will be billed to you.

Billing Questions

If you should need any assistance or have questions, please contact our billing department between 9:00am and 4:00pm Monday through Friday by calling the regular office number and selected option 6.

Refunds

Overpayments will be refunded upon written request to the responsible party within 30 days of our office confirmation.

Missed appointments/Cancellations

Missed appointments represent a cost to us, to you and to other patients who could have been seen in the time frame set aside for you. If you are unable to keep an appointment, please give as much notice as possible. We charge $25.00 for any appointment cancelled within 24 hours and we also charge $25.00 for any scheduled appointment that is missed. Excessive abuse of scheduled appointments may result in discharge from the practice.

Forms

We provide a completed daycare/school form as well as the immunization record at each physical examination. This is good for one calendar year for school, sports, camps, and daycare. We suggest that you make several copies to provide to others who need the form. If you request us to provide you with another form there is a $15.00 charge to do so. Once we receive the request we will provide that for you in 3-5 days. Any form that is needed within 24 hours will be subject to an additional $10.00 charge. Additional school forms such as medication forms, asthma forms, allergy forms etc. will be completed without charge in 3-5 business days. If you require a form within 24 hours, a $10.00 charge will be assessed.