Policies

As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We are more than willing to discuss any questions you may have about vaccines, but do require all new patients to our practice to adhere to the vaccination schedule endorsed by the American Academy of Pediatrics (AAP)

• We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives. 
• We firmly believe in the safety of our vaccines.
• We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). 
• We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities. 
• We firmly believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities.
• We firmly believe that vaccinating children and young adults may be the single most important health promoting intervention we perform as health care providers, and that you can support as parents/caregivers.

The recommended vaccines and the schedule of administration 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.

The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.

Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR (measles, mumps, rubella) vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of under-immunization, there have been small outbreaks of measles and several deaths from complications of measles in Europe over the past several years. The United States experienced a record number of measles cases during 2019, with 1282 cases from 31 states reported to 

. This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.

 If vaccinating your child on schedule is not part of your healthcare goal then we will not be a good fit for you.                                                                                              

PAYMENT POLICIES

Thank you for choosing Pediatric Dream Care for your child’s medical care. We are providing you with the following information to help you understand our insurance and billing policies.

• You must show your current insurance card on every visit. This is to protect you from receiving a bill because we did not have the correct insurance information. We will attempt to validate your insurance benefits at the time of service and alert you to any problems. If we cannot validate your coverage, we may assign your account to self-paid status and request full payment at the end of your visit.
• You must pay your co-payment at the time of the office visit. Our contracts with insurance companies require us to collect your co-pay at the time of service. We accept cash, credit cards (VISA, MasterCard) as forms of payment. Late co-pays are subject to an additional $20 service fee.
• If your insurance plan is subject to routine deductibles and co-insurance, we require you to keep a credit card on file so we can collect those charges as soon as your insurance carrier assigns the appropriate amount of patient responsibility. During the time you leave a  credit card on file, if it expires or otherwise becomes uncollectable, we will expect you to promptly provide a new means of payment.
• You must cancel any appointment for a well visit/check-up at least 24 hours prior to your scheduled start time. Otherwise, you will be assessed a missed appointment fee based on the length of the appointment: $35 for follow up visit/sick visit and $50 for new patient and well visit.
• Know your insurance benefits. Your insurance policy is a contract between you and your  insurance company, even if your employer provides it. There are many subtle differences in insurance policies, and employers frequently change coverage and co-payments. You are responsible for knowing what services are covered (and how often, in the case of well visits), and how much of the cost is your responsibility. You will be responsible for any portion of services that your insurance doesn’t cover, or for which you have a deductible that has not yet been met. You should also be aware of where your insurance wants you to go for any lab or radiology procedures so that in an urgent situation, you are seen at the appropriate facility and will not receive a bill.
• If your insurance plan requires you to choose a primary care provider, you must contact your carrier and select our office as soon as your medical records are transferred. In accordance with carrier guidelines, we cannot schedule any appointments or write any referrals until we receive notice that you have been added to our roster.
• The initial newborn visit and the second visit within the first month of birth will be $100 each, payable at the time of the visit if the patient does not have active insurance. Then, during the first month, when insurance is active, we bill the insurance, and if the insurance covers the visit, the $100 paid for each visit will be reimbursed. If insurance does not cover the cost of the visits, or any of them, the $100 for the visit not covered by insurance will be considered payment for the visit.

Insurance coverage. You should contact your carrier as soon as feasible to add the new child to your policy. You must have your child added to your policy by the one-month well-visit and should have an insurance card to present at that visit. If you have not received an insurance card, contact your insurance company prior to the visit to verify coverage and get an active insurance ID number. If you do not have active coverage your visit may be rescheduled/delayed, or you may be personally responsible for the bill.

• If your child is covered by more than one insurance policy, be sure you know which is considered primary. We must submit claims to the appropriate carrier(s) in the right order.
• Carefully read all Explanation of Benefits (EOB) statements you receive from your insurance carrier. We receive the same statements and any charges which your insurance carrier designates as “patient responsibility” will be billed to you directly from our office if you do not have a credit card on file. 
• If your account is self-paid, all services must be paid for at the time of your visit. This may include situations where we cannot validate active coverage with your insurance carrier. In such cases, we will collect payment at the time of service and refund any amount subsequently collected from your carrier.
• If you have valid coverage with a participating insurance carrier, we will file an insurance claim after your date of service. If there are any problems with this submission, we will notify you immediately and request your prompt assistance with any conditions under your control that are causing a delay in processing. If your insurance carrier does not respond within 30 days, we will submit a second claim. If your insurance carrier does not respond to our secondary submission within 60 days from the original date of service, we will send you a statement, and payment will become your responsibility. You will need to contact your insurance carrier if you think it is responsible for payment. We will expect payment from you or them within 30 days of receipt of your statement.
• If your participating insurance policy is subject to routine deductibles and/or co-insurance that cannot be collected on the date of service, we will charge your credit card on file as soon as your carrier provides an EOB designating your financial responsibility for the claim. We will only charge your credit card without prior notice if, in our sole opinion, the claim was adjudicated normally. If the claim is denied, we will contact you to resolve the situation before collecting any amounts indicated as due or non-covered services.
• If you are insured by a non-participating insurance carrier, we will expect payment from you at the time of service, and it will be your responsibility to submit any claims to your insurance company for direct reimbursement to you. We will provide you with the appropriate information to assist you in this process.  
• All statements are due on receipt. If charges remain unpaid after 30 days, a second statement will be rendered with a notice requesting immediate payment. If charges remain unpaid after 60 days, a final statement will be rendered with a letter informing you that our relationship is subject to cancellation after 30 days of urgent and emergent care. All further services will be provided on a cash-only basis.
• We reserve the right to place your account with our collection agency after all internal efforts to obtain payment have been exhausted. You are then responsible for any collection costs in addition to your outstanding bill. If you are presently in the collection, the practice will use its discretion to provide you with further treatment or ask you to find another physician.

Pediatric Dream Care, PA Notice of Privacy Practices Effective 07/01/2023

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability & Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This Notice describes your right to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our Practice except when the release is required or authorized by law or regulation.

OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION “Protected health information” (PHI) is individually identifiable health information and includes demographic information. It relates to your past, present or future health, and related healthcare services. Our Practice is required by law to do the following: (1) keep your protected health information private; (2) present to you this Notice of our legal duties and privacy practices related to the use and disclosure of your protected health information; (3) follow the terms of the Notice currently in effect; (4) post and make available to you any revised Notice; and (5) notify affected individuals following a breach of unsecured protected health information. We reserve the right to revise this Notice and to make the revised Notice effective for the health information we already have about you as well as any information we receive in the future. The Notice’s effective date is at the top of the first page and at the bottom of the last page.

Required Uses and Disclosures By law, we must disclose your health information to you unless it has been determined by a healthcare professional that it would be harmful to you. Even in such cases, we may disclose a summary of your health information to certain of your authorized representatives specified by you or by law. We must also disclose health information to the Secretary of the U.S. Department of Health and Human Services (HHS) for investigations or determinations of our compliance with laws on the protection of your health information.

Treatment We will use and disclose your protected health information to provide, coordinate or manage your health care. This includes the coordination or management of your health care with a third party. In emergencies, we will use and disclose your protected health information to provide the treatment you require.

Payment Your protected health information may be used to obtain payment for your health care services. We may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members or to bill you directly for services and items.

Health Care Operations We may use or disclose your protected health information to support our daily activities related to providing health care. These activities include billing, collection, quality assessment, licensing, and staff performance reviews. We will share your protected health information with other persons or entities who perform various activities for our Practice. These business associates of our Practice are also required by law to protect your health information.

Required by Law We may use or disclose your protected health information if law or regulations require the use or disclosure.

Public Health We may disclose your protected health information to a public health authority that is permitted by law to collect or receive the information. We may provide proof of immunization without authorization, to your school if (i) the school is required by State or other law to have proof of immunization prior to admission and (ii) we obtain and document your permission or, for a minor, the permission of the parent, guardian or other person acting in loco parentis for the individual.

Communicable Diseases We may disclose your protected health information to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, or other regulatory programs.

Food and Drug Administration We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events; track products, enable product recalls; make repairs or replacements; or conduct post-marketing review.

Legal Proceedings We may disclose protected health information during any judicial or administrative proceeding, in response to a court order or administrative tribunal, and in certain conditions in response to a subpoena, discovery request, or other lawful process.

Law Enforcement We may disclose protected health information for law enforcement purposes, including information requests for identification and location; and circumstances pertaining to victims of a crime.

Coroners, Funeral Directors, and Organ Donations We may disclose protected health information to coroners or medical examiners for identification to determine the cause of death or for the performance of other duties authorized by law. We may also disclose protected health information to funeral directors as authorized by law. Protected health information may be used and disclosed for cadaver organ, eye, or tissue donations.

Research We may disclose protected health information to researchers when authorized by law, for example, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Threat to Health or Safety Under applicable Federal and State laws, we may disclose your protected health information to law enforcement or another healthcare professional if we believe in good faith that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities believed necessary by appropriate military command authorities to ensure the proper execution of the military mission, including determination of fitness for duty; or to a foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information, under specified conditions, to authorized Federal officials for conducting national security and intelligence activities including protective services to the President or others.

Workers’ Compensation We may disclose your protected health information to comply with workers’ compensation laws and similar government programs.

Inmates We may use or disclose your protected health information, under certain circumstances, if you are an inmate of a correctional facility.

Parental Access State laws concerning minors permit or require certain disclosure of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the laws of this State (or, if you are treated by us in another state, the laws of that state) and will make disclosures following such laws.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR PERMISSION - In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.

Individuals Involved in Your Health Care Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. We may also give information to someone who helps pay for your care. Additionally, we may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person who is responsible for your care, of your location, general condition, or death. If you should become deceased, we may disclose your protected health information to a family member or other individual who was previously involved in your care, or in payment for your care, if the disclosure is relevant to that person’s prior involvement, unless doing so is inconsistent with your prior expressed preference. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your health care.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION - You may exercise the following rights by submitting a written request to our HIPAA Manager. Our HIPAA Manager can guide you in pursuing these options. Our Practice may deny your request; however, in most cases, you may seek a review of the denial.

Right to Inspect and Copy You may inspect and/or obtain a copy of your protected health information that is contained in a “designated record set” for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that our Practice uses for making decisions about you. This right does not include inspection and copying of the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. You will be charged a fee for a copy of your record, and we will advise you of the exact fee at the time you make your request. We may offer to provide a summary of your information and, if you agree to receive a summary, we will advise you of the fee at the time of your request.

Right to Request Restrictions You may ask us not to use or disclose any part of your protected health information for treatment, payment, or health care operations. Your request must be made in writing to our HIPAA Manager. In your request, you must tell us: (1) what information you want to restrict; (2) whether you want to restrict our use or disclosure, or both; (3) to whom you want the restriction to apply, for example, disclosures to your spouse; and (4) an expiration date. If we believe that the restriction is not in the best interests of either party or that we cannot reasonably accommodate the request, we are not required to agree to your request. If the restriction is mutually agreed upon, we will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment. You may ask us not to disclose certain information to your health plan. We must agree with that request only if the disclosure is not for the purpose of carrying out treatment (only for carrying out payment or health care operations) and is not otherwise prohibited by law and pertains solely to a health care item or service for which we have been paid out of pocket in full by you or by another person on your behalf other than your health plan. You may revoke a previously agreed upon restriction, at any time, in writing.

Right to Request Alternative Confidential Communications You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible.

Right to Request Amendment If you believe that the information, we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment.

Right to an Accounting of Disclosure, You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment, or health care operations as described in this Notice and excludes disclosures made directly to you, to others pursuant to authorization from you to family members or friends involved in your care, or for notification purposes. The accounting will only include disclosures made no more than 6 years prior to the date of your request. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this Notice.

Rights Related to an Electronic Health Record – If we maintain an electronic health record containing your protected health information, you have the right to obtain a copy of that information in an electronic format and you may choose to have us transmit such copy directly to a person or entity you designate, provided that your choice is clear, conspicuous, and specific. You may request that we provide you with an accounting of the disclosures we have made of your protected health information (including disclosures related to treatment, payment, and healthcare operations) contained in an electronic health record for no more than 3 years prior to the date of your request (and depending on when we acquired an electronic health record).

Right to Obtain a Copy of this Notice You may obtain a paper copy of this Notice from us, view or download it electronically at our Practice’s website at

www.pediatricdreamcare.com.

Complaints If you believe these privacy rights have been violated, you may file a written complaint with our HIPAA Manager or with the U.S. Department of Health and Human Services Office for Civil Rights (OCR). We will provide the address of the OCR Regional Office upon your request. No retaliation will occur against you for filing a complaint.

CONTACT INFORMATION - You may contact our HIPAA Manager for further information about our complaint process or for further explanation of this Notice of Privacy Practices by calling the office at (561) 621-1801.

Pediatric Dream Care, PA Notice of Privacy Practices Effective 07/01/2023

Terminating Patient Relationships: Despite the best efforts, it may become necessary to end patient relationships that are no longer therapeutic or appropriate. Prior to terminating a patient relationship, we will address the underlying reasons with the patient/guardian. If efforts to rehabilitate the relationship are not appropriate or are unsuccessful, the patient’s physician and the Practice Manager will analyze the case and send a termination letter to the address the patient has on file. Circumstances for termination are:

-Treatment nonadherence: The patient does not follow the treatment plan or the terms of a pain management contract or discontinues medication or therapy regimens before completion.

-Follow-up noncompliance: The patient repeatedly cancels follow-up visits or fails to keep scheduled appointments with practitioners or consultants.

-Office policy noncompliance: The patient fails to observe office policies, such as those implemented for prescription refills or appointment cancellations or refuses to adhere to mandated infection-control precautions.

-Verbal abuse or violence: The patient, a family member, or a third-party caregiver is rude, uses disparaging or demeaning language, or sexually harasses office personnel or other patients, visitors, or vendors; exhibits violent or irrational behavior; makes threats of physical harm; or use anger to jeopardize the safety and well-being of anyone present in the office. Office staff may need to contact law enforcement promptly for support to help ensure that the situation does not escalate.

-Display of firearms or other type of weapons: The patient, a family member, or a third-party caregiver threatens practice operations by wielding a firearm or weapon on the premises. Office staff may need to contact law enforcement promptly for support to help ensure that the situation does not escalate.

-Inappropriate or criminal conduct: The patient exhibits inappropriate sexual behavior toward practitioners or staff or participates in drug diversion, theft, or other criminal conduct involving the practice.

-Nonpayment: The patient owes a backlog of bills and has declined to work with the office to establish a payment plan or has discontinued making payments that had been agreed previously.

-Age limits: When the patient turns 18, we will advise them to find an adult primary care physician, which will facilitate their care. Upon reaching this age, they will be automatically deactivated from our office.

-Violation of our policy: Any patient or family member who in any way continues to fail to comply with the Pediatric Dream Care, PA Policy after a prior warning (verbal or written) has been made.