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Our billing department will apply on your behalf the coverage of the medical services provided by this medical facility, by submitting your claims to your insurance company. Our billing department may be required to release necessary medical information to your insurance company, to determine the insurance benefits of which you may be entitled, in order to process your claims. This is a courtesy that may be withdrawn, if your insurance company becomes unresponsive in making payments.


Although we will make every attempt to receive verification of coverage before services are provided, our office DOES NOT guarantee that your insurance company will pay for provided medical services. It must be FULLY understood that your insurance contact is between you and your insurance company and it is your sole responsibility to know and understand what is/is not covered by your medical insurance policy.


You understand and agree that if it is determined that your insurance is not in effect on the date services are provided, or if your insurance claim is denied for any reason, you will be financially responsible for all total amounts due on your bill and you agree to pay all existing and future indebtedness to this medical facility for medical services that may not be covered by your medical insurance company.  

If there is a pending insurance claim, you will continue to receive monthly statements from this medical facility listing all changes, payments, adjustments and the current amount. Charges on the statement will reflect services provided within this medical facility ONLY, and will NOT reflect charges from Mary Washington Hospital, or for services provided by other medical physician's facilities. 

Other Policies:
  • There is a $75 fee for each missed appointment. If you no longer need the appointment or know that you will miss your appointment, please call to cancel as soon as possible to avoid this fee.

  • There is a $15 non-sufficient fund charge for all returned checks.

  • We reserve the right to dismiss your child from our practice after 3 missed appointments.

  • Please arrive on time for your appointments. You will be asked to reschedule if you arrive more than 15 minutes late to your appointment.

  • Please allow 48 hours for medication refill requests to be completed.

  • Please allow 72 hours for completion of forms and referrals. 

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