Policies

Everyone's Time is Equally Valuable.

We ask that you arrive 5 minutes before your scheduled appointment time. We understand sometimes things happen beyond your control that may cause you to be late. However, we reserve the right to ask you to reschedule if you arrive 15 minutes late for your appointment.

Our practice makes every effort to run on time with appointments, as we believe everyone’s time is equally valuable.

Missed appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. Missing multiple appointments without 24h notice may results in discharge from the practice.

THIS NOTICE OF PRIVACY PRACTICES (THE “NOTICE”) DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

This Notice applies to the Pediatric Associates.  The purpose of this Notice is to describe how Pediatric Associates may use and disclose your protected health information (“PHI”) in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), the Health Information Technology for Economic and Clinical Health Act (the “HITECH Act”) and the HIPAA Omnibus Final Rule (the “Final Rule”).  This Notice also describes the obligations of Pediatric Associates with respect to your protected health information, describes how your protected health information may be used or disclosed to carry out treatment, payment or healthcare operations, and describes your rights to control and access your protected health information. Pediatric Associates has agreed to the provisions set forth in this Notice.

We are required to provide this Notice to you pursuant to HIPAA.

The HIPAA Privacy Rule protects only certain medical information known as “protected health information.” Generally, protected health information is health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan, from which it is possible to individually identify you and that relates to:

(a)     your past, present, or future physical or mental health or condition; 

(b)     the provision of health care to you; or 

(c)     the past, present, or future payment for the provision of health care to you. 

1.    Responsibilities of Pediatric Associates.  

Pediatric Associates is required under HIPAA to maintain the privacy of your protected health information. Protected health information includes all individually identifiable health information transmitted or maintained by Pediatric Associates that relates to your past, present or future health, treatment or payment for health care services.  Pediatric Associates must abide by the terms of this Notice, and must provide you with a copy of this Notice upon request.

2.    How Pediatric Associates May Use and Disclose Your Protected Health Information. 

The following categories describe the different situations in which Pediatric Associates is permitted or required to use or disclose your protected health information:

• For Treatment. Pediatric Associates may use or disclose your protected health information to facilitate medical treatment or services by providers. Pediatric Associates may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. 
• For Payment Purposes. Pediatric Associates has the right to use and disclose your protected health information to satisfy their responsibilities with respect to the billing and payment collected from you, an insurance company or a third party, for treatment and services you receive from Pediatric Associates.  For example, Pediatric Associates may need to give your health plan information about therapy or nursing services you receive in order to receive reimbursement from your health plan for those services.  Pediatric Associates may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
• Health Care Operations. Pediatric Associates has the right to use and disclose your protected health information to perform functions necessary for the operation of Pediatric Associates. For example, Pediatric Associates may use health care information to review Pediatric Associates’ treatment and services and to evaluate the performance of our staff in caring for you.  Pediatric Associates may combine health care information about many of our patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective.  Pediatric Associates may also disclose information to doctors, nurses, therapists, technicians, aides, students and other Pediatric Associates personnel for review and learning purposes.  Pediatric Associates may remove information that identifies you from the health care information so others may use it to study health care and health care delivery without learning the identity of any specific patient.
•  Appointment Reminders.  Pediatric Associates may use and disclose health care information to contact you as a reminder that you have an appointment with Pediatric Associates.
• Treatment Alternatives.  Pediatric Associates may use and disclose health care information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
• Health-Related Benefits and Services.  Pediatric Associates may use and disclose health care information to tell you about health-related benefits or services that may be of interest to you.
• To the Individual.  Pediatric Associates may disclose protected health information, which you are the subject of, to you.
• Individuals Involved in Your Care or Payment for Your Care.  Pediatric Associates may release health care information about you to a friend or family member who is involved in your health care.  Pediatric Associates may also give information to someone who helps pay for your care.  In addition, we may disclose health care information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.  This release requires written or oral consent from you.
• Research.  Under certain circumstances, Pediatric Associates may use and disclose health care information about you for research purposes.  For example, a research project may involve comparing the health and recovery of all parties who received one type of treatment to those who received another for the same condition.  All research projects, however, are subject to a special approval process.  This process evaluates a proposed research project and its use of health care information, trying to balances the research needs with patients’ need for privacy of their health care information.  Before we use or disclose health care information for research, the project will be approved through this research approval process, but Pediatric Associates may, however, disclose health care information about you to people preparing to conduct a research project, for example, to help them look for patients with specific health care needs, so long as the health care information they review does not leave our control.  We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care with us.
• Business Associates. Pediatric Associates may contract with certain service providers (“Business Associates”) to perform various functions on behalf of Pediatric Associates. To provide these services, the Business Associates may receive, create, maintain, use or disclose protected health information. Pediatric Associates and each Business Associate will enter into, or have already entered into, an agreement requiring the Business Associate to safeguard your protected health information as required by law and in accordance with the terms of this Notice. 
• Required By Law. Pediatric Associates may use or disclose your protected health information to the extent required by federal, state or local law. For example, Pediatric Associates may disclose your protected health information when required by national security laws or public health disclosure laws.
• Lawsuits and Disputes. Pediatric Associates may disclose your protected health information in response to a court or administrative order. Your protected health information may also be disclosed in response to a subpoena, discovery request or other lawful process if efforts have been made to tell you about the request or to obtain an order protecting your protected health information.
• Certain Government Agencies and Officials. Pediatric Associates may disclose your protected health information to (i) government agencies involved in oversight of the health care system, (ii) government authorities authorized to receive reports of abuse, neglect or domestic violence, (iii) law enforcement officials for law enforcement purposes, (iv) military command authorities, if you are or were a member of the armed forces, (v) correctional institutions, if  you are an inmate or in under the custody of a law enforcement official  and (vi) federal officials for intelligence, counterintelligence, and other national security activities.
• Public Health and Research Activities; Medical Examiners. Pediatric Associates may also disclose your protected health information (i) for public health activities or to prevent a serious threat to health and safety, (ii) to organizations that handle organ donations, if you are an organ donor, (iii) to coroners, medical examiners and funeral directors as necessary, and (iv) to researchers, if certain conditions regarding the privacy of your protected health information have been met.
• Workers’ Compensation. Pediatric Associates may disclose your protected health information to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
• Military and Veterans.  If you are a member of the armed forces, Pediatric Associates may release health care information about you as required by military command authorities. We may also release health care information about foreign military personnel to the appropriate foreign military authority.
• Disclosures to the Secretary of the U.S. Department of Health and Human Services. Pediatric Associates may be required to disclose your protected health information to the Secretary of the U.S. Department of Health and Human Services to investigate or determine Pediatric Associates’ compliance with the HIPAA Privacy Rules.
• Other Uses and Disclosures With Written Authorization.  Disclosures and uses of your protected health information that are not described above may be made by Pediatric Associates with your written authorization. If Pediatric Associates is authorized to use or disclose your protected health information, you may revoke that authorization, in writing, at any time, except to the extent that Pediatric Associates has taken action relying on the authorization. Pediatric Associates will not be able to take back any disclosures of your protected health information that have already been made with your authorization.

3.    Your Rights With Respect to Your Protected Health Information.

The following summarizes your rights with respect to your protected health information: 

• Right to Request a Restriction on Uses and Disclosures of Protected Health Information. You have the right to request a restriction or limitation on the protected health information used or disclosed about you by Pediatric Associates for treatment, payment or health care operations. You also have the right to request a limit on the disclosure of your protected health information to someone who is involved in your care or the payment for your care, such as a family member, friend or other person you have identified as responsible for your care. In your request, you must tell Pediatric Associates (i) what information you want to limit; (ii) whether you want to limit Pediatric Associates’ use, disclosure, or both; and (iii) to whom you want the limits to apply, for example, disclosures to your spouse.  Pediatric Associates will comply with any restriction request if (iv) except as otherwise required by law, the disclosure is to the health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (v) the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid out-of-pocket in full.  If Pediatric Associates agrees to your request, Pediatric Associates will honor the restriction until you revoke it or we notify you.
• Right to Request Confidential Communications. You have the right to request that Pediatric Associates communicate with you about your protected health information in a certain way or at a certain location. For example, you can request that Pediatric Associates only contact you at work or by mail. Pediatric Associates will accommodate all reasonable requests.
• Right to Inspect and Copy Your Protected Health Information. You have the right to inspect and copy your protected health information. Under certain limited circumstances, we may deny your access to a portion of your records. For example, you do not have a right to inspect and copy psychotherapy notes or information that Pediatric Associates have collected in connection with, or in reasonable anticipation of, any legal claim or proceeding. If you request copies, we may charge you reasonable copying and mailing costs.
• Right to Amend Your Protected Health Information. You have the right to request an amendment of your protected health information that is maintained by Pediatric Associates if you believe that the information is inaccurate or incomplete. Pediatric Associates may deny your request if your protected health information is accurate and complete or if the law does not permit Pediatric Associates to amend the requested information. Pediatric Associates cannot amend information created by your doctor or any person other than Pediatric Associates.
• Right to Receive an Accounting of Disclosures of Your Protected Health Information. You have the right to request an accounting of disclosures Pediatric Associates has made of your protected health information during the six (6) years prior to the date of your request. However, you will not receive an accounting of (i) disclosures made prior to April 14, 2003, (ii) disclosures made to you, (iii) disclosures made pursuant to your authorization, (iv) disclosures for purposes of treatment, payment or health care operations  and (v) disclosures made to friends or family in your presence or because of an emergency. Certain other disclosures are also excepted from the HIPAA accounting requirements. If you request more than one accounting in any twelve (12) month period, Pediatric Associates will charge you a reasonable fee for each accounting after the first accounting statement.
• Uses and Disclosures that Require Your Authorization. The following uses and disclosures will be made by Pediatric Associates only with your authorization: 

1. uses and disclosures for marketing purposes, including subsidized treatment communications; 
2. uses and disclosures that constitute the sale of PHI;
3. if Pediatric Associates maintains psychotherapy notes, the use and disclosure of such notes will only be made upon the authorization from you; and other uses and disclosures not described in this Notice. 

You may revoke your authorization at any time, so long as the revocation is in writing. Once we receive your written revocation, it will only be effective for future uses and disclosures. It will not be effective for any information that may have been used or disclosed in reliance upon the written authorization and prior to receiving your written revocation.

• Right to Opt-Out of Fundraising Communications. If Pediatric Associates conducts or engages in fundraising communications, you shall have the right to opt-out of such fundraising communications.
• Right to Receive a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice upon request, even if you agreed to receive this Notice electronically. To obtain a paper copy of this Notice, contact TERI PERSINGER at 905 OLD DILEY ROAD, PICKERINGTON, OHIO 43147 (614) 864-3222.
• Right to Be Notified of a Breach. You have the right to be notified in the event that Pediatric Associates (or a Business Associate) commits or discovers a breach of unsecured protected health information.
• To Exercise Your Individual Rights. To exercise any of your rights listed above, you must complete the appropriate form. To obtain the required form, please contact TERI PERSINGER at 905 OLD DILEY ROAD, PICKERINGTON, OHIO 43147 

4.    Filing a Complaint With Pediatric Associates or the U.S. Dept. of Health and Human Services.

If you believe that Pediatric Associates has violated your HIPAA privacy rights, you may complain to Pediatric Associates or to the Secretary of the U.S. Department of Health and Human Services.  Complaints to Pediatric Associates should be sent to SANDRA BOYLE, MD 1021 COUNTRY CLUB ROAD SUITE A COLUMBUS, OHIO 43213.   Complaints to the Secretary should be sent to the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Ave. S.W., Washington, D.C. 20201. Pediatric Associates will not penalize you or retaliate against you for filing a complaint.

5.    Changes to this Notice.

Pediatric Associates reserves the right to change the provisions of this Notice and to apply the changes to all protected health information received and maintained by Pediatric Associates. If Pediatric Associates makes a material change to this Notice, a revised version of this Notice will be provided to you within thirty (30) days of the effective date of the change at your address of record.

6.    Effective Date.

This Notice becomes effective on NOVEMBER 1, 2014.

7.    Contact Information.

If you have any questions regarding this Notice or would like to exercise any of your rights described in this Notice, please contact:

Pediatric Associates 

Attention: TERI PERSINGER 

905 OLD DILEY ROAD

PICKERINGTON, OHIO 43147

Telephone:   (614) 864-3222

We Are Committed to Providing You With the Best Possible Medical Care

We make every effort to keep our fees reasonable while at the same time covering the cost of the services we provide. Please read the following policies carefully to ensure you understand the financial implications.

As physicians, our relationship is with you and your child, not your insurance company. If you have insurance that we contract with, we will bill your insurance company for you. However, all charges are ultimately your responsibility. It is essential for you to be familiar with your insurance policy and know what services are covered under your policy.

Diagnoses are made based on medical information, not based on coverage by insurance companies. To request a diagnosis change solely for the purpose of securing reimbursement from an insurance carrier is inappropriate and is considered insurance fraud.

When significant problems are uncovered or addressed at a well visit/check-up, an additional charge may be incurred. Examples include asthma, ADHD, behavioral concerns, developmental and speech delays, growth problems including overweight and obesity, headaches or abdominal pain. These problems are not included in insurance coverage of preventive medicine services, but are often critical to the health of your child and must be addressed at the checkup. Even if you do not have concerns about the condition yourself. Insurance companies have various ways of handling this situation, ranging from full coverage to co-payment to no coverage. It is your responsibility to know how your insurance carrier handles this and to make arrangements for a separate problem focused visit to address these concerns if needed.

There is an additional charge for walk in/emergency visits and copying of records. Immunization records are provided free of charge.

We will ask to see ALL your current insurance card(s) at every visit. Insurance companies will deny payment if insurance has lapsed for any reason or if you carry secondary or additional insurance that we are not aware of. Failure to disclose current and accurate insurance coverage is considered insurance fraud and will result in dismissal from our practice.

If we are not contracted with your insurance company, cannot verify your insurance coverage, or you do not have insurance, full payment is due at the time of service.

Co-pays are due at the time of service. We do not bill secondary insurance for co-pays. You will need to bill your secondary insurance for this amount. Please remember that your co-pay amount and your plan coverage are determined by your insurance company, not Pediatric Associates, and as such, we have no control over the cost of these items. If you are unable to pay your co-pay at the time of service, an administrative fee of $20 for each co-pay not paid will be assessed and you will be asked to sign a co-pay violation acknowledgement.

If your claim is not paid by your insurance company, you will be billed.

• All balances billed are due within 30 days of the statement date.
• Any bill that has not been addressed within 30 days of statement date will be sent to collections and all children on the account will be placed in collection status. While in collection status, all checkups and non-urgent services will be suspended until payment arrangements are made with the billing department. We will request to speak with you regarding payment for urgent services such as ill visits, prescriptions, phone nurse calls and physician calls.
• If needed, our billing department can arrange a payment schedule. Payments arrangements require payments every 30 days. If a payment is not made every 30 days, the payment arrangement will be voided and the account will be placed in collection status. A second payment arrangement will NOT be made if the original payment arrangement is voided due to non-payment.
• Our office will dismiss the entire family from the practice if the account remains unpaid. Once an account goes into dismissal status, 30 days of ill care will be provided. After these 30 days, no further care will be provided until the entire balance is paid in full. Once the account balance has been paid in full, the dismissal status will be removed from the account. 

We do not bill insurance companies for Workers Compensation or automobile accidents. When seen for these services, we require payment in full at the time of service. It is your responsibility to submit your bill to the appropriate insurance agency for reimbursement.

We send all labs and xrays to Nationwide Children’s Hospital facilities. If Nationwide Children’s Hospital is not your insurance provider’s preferred facility, it is your responsibility to let us know what facility is preferred. We do not bill any charges for outside facilities, including Nationwide Children’s Hospital and cannot waive or reduce the fees these outside facilities charge.

We do dismiss families from our practice for frequent no-shows. Please give us 24 hours of notice when cancelling appointments.

You may receive notification from our office if your account requires immediate attention. Examples include addition of a newborn to your insurance policy (this must be done within 30 days of birth), name or birth date corrections (these must match your insurance policy), your account shows no active insurance, or your insurance company has requested a coordination of benefits (insurance companies will not accept this information from us). Please address these notifications as soon as possible as failure to do so will result in dismissal from the practice until the notification issue has been resolved.

We accept cash, checks, VISA, MasterCard and Discover Card. Returned checks are automatically sent to our collection agency. The collection agency assesses a $30 charge for each returned check.

Please note that any refunds issued will be sent to the person who is listed as being financially responsible on the account.

We realize that temporary financial problems may affect timely payment on your account. If problems do arise, we encourage you to contact our billing department for assistance at (614) 501-7337.

I have read and understand the above financial policy and agree to adhere to its contents. 

We Believe In Vaccinating

We firmly believe in the safety and effectiveness of vaccines to prevent serious illness and to save lives.  We are more than willing to discuss any questions you may have about vaccines, but do require all patients to our practice to adhere to the vaccination schedule outlined by the  Centers for Disease Control and Prevention  (CDC) and the  American Academy of Pediatrics  (AAP). 

These routine vaccines are given at well child visits.  Additionally, seasonal vaccines (like the flu shot) can also be given at sick visits or vaccine only visits (click here to schedule a vaccine only visit).