Policies
Financial Policy
Payment
Co-Payments are due at the time of service. We accept cash, personal checks, debit cards, MasterCard, Visa, Discover, American Express, and money orders. For your convenience, we can keep a credit card on file. A payment plan can be arranged, if necessary.
If your account has a personal balance over $10, you will receive statements monthly. Please pay these in a timely fashion. Patients who do not pay overdue balances nor arrange a payment plan with our Billing Office, will be discharged from our practice.
To pay your balance on line, please click here.
Billing Insurance
We will bill participating insurance companies for you. If we do not participate with your insurer, we expect you to pay us directly and we will give you the forms to submit to your insurer.
Late Arrival Policy
Please help us serve all of our families better by being on time for your appointment. If you are more than 10 minutes late for your appointment you will likely be asked to reschedule the appointment.
Additional Concerns During Well Visit
Effective October 1, 2015, changes in legislation require that any care provided outside of a standard well check up will need to be documented and billed separately and will involve a copay. For further information, please click here.
See our complete Financial Policy.
Questions about financial policy, fees, insurances, or billing?
Contact our billing specialist:
Monday - Thursday 8:00 am to 3:00 pm
Friday- 8:00 am to 2:00 pm
Phone: (616) 957-5165 extension 315 or 331
Insurance Policy
We participate with the following insurance companies (see links below): Aetna, Blue Cross Blue Shield, Blue Care Network (NOT BCN partnered), Cofinity, Messa, Physician's Care, Priority Health, Priority Health Medicaid, Tricare Standard, and United Health Care.
Please bring your current insurance card to each visit so that we can bill the proper insurance company.
If we do not participate with your insurer, we expect you to pay us directly and we will provide receipts for you to submit to your insurance carrier. If your account has a personal balance due of $10 or more, you will receive a monthly statement if there is a past due balance.
Questions about financial policy, fees, insurances, or billing?
Contact our billing specialist:
Monday - Thursday 8:00 am to 3:00 pm
Friday- 8:00 am to 2:00 pm
Phone: (616) 957-5165 extension 315 or 331
Insurances We Participate With
Aetna (PPO & Managed Care)
Blue Care Network
(phone numbers vary, check your id card)
Blue Cross Blue Shield (NOT BCBS Medicaid/Complete or Blue HPN)
(phone numbers vary, check your id card)
Cofinity
(phone numbers vary, check your id card)
Medicaid (Established Patients ONLY)
Physicians Care-ASR
Priority Health, Priority Health Medicaid, Priority Health-CIGNA (Strategic Alliance)
Tricare Standard (formerly Champus)
Tricare has 2 websites: www.mytricare.com and www.hnfs.com
United Healthcare (SELECT PLANS ONLY/DO NOT ACCEPT UHC MEDICAID OR CORE
please check your provider directory)
(phone numbers vary, check your id card)
Privacy Policy HIPAA
We know that keeping your personal information private is important to you. That's why Forest Hills Pediatric Associates wants you to know how we protect the information that you share with us.
We have built our practice on a foundation of integrity, honesty, and trust. These values are reflected in our commitment to protect your privacy.
This Notice of Privacy Practices is NOT an authorization. It describes how we, our Business Associates, and their subcontractors, may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected Health Information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental condition and related health care services.
Your Rights Under The Privacy Rule
Please feel free to discuss any questions with our staff.
You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices—We are required to follow the terms of this notice. We reserve the right to change the terms of our notice at any time. Upon your request, we will provide you with a revised Notice of Privacy Practices if you call our office and request that a revised copy be sent to you in the mail or ask for one at the time of your next appointment.
You have the right to authorize other use and disclosure—This means without your authorization, we are expressly prohibited to use or disclose your PHI for marketing purposes. We may not sell your PHI without your authorization. We may not use or disclose most psychotherapy notes contained in your protected health information. We will not use or disclose any of your PHI that contains genetic information that will be used for underwriting purposes.
You may revoke the authorization, at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request an alternative means of confidential information—This means you have the right to ask us to contact you about medical matters using an alternative method (i.e. email, text, telephone), and to a destination (i.e. cell phone number, alternate address, etc.) designated by you. You must inform us in writing, using a form provided by our practice, how you wish to be contacted if other than the address/phone number that we have on file. You may also go to our website to change your preferred method of contact. We will allow all reasonable requests.
You have the right to inspect and copy your PHI—This means you may inspect and obtain a copy of your complete health record. If your health record is maintained electronically, you will also have the right to request a copy in electronic format. We have the right to charge a reasonable fee for paper of electronic copies as established by professional, state, or federal guidelines.
You have the right to request a restriction of your PHI—This means you may ask us, in writing, not to use or disclose any part of your protected health information for the purpose of treatment, payment or healthcare operations. If we agree to the requested restriction, we will abide by it, except for in emergency circumstances when the information is needed for your treatment. In certain cases, we may deny your request for a restriction. You have the right to request, in writing, that we restrict communication to your health plan regarding a specific treatment or service that you, or someone on your behalf, has paid for in full, out of pocket. We are not permitted to deny this specific type of requested restriction.
You may have the right to request an amendment to your protected health information—This means you may request an amendment of your PHI for as long as we maintain this information. In certain cases, we may deny your request.
You have the right to receive a privacy breach notice—You have the right to receive written notification if the practice discovers a breach of your unsecured PHI, and determines through a risk assessment that notification is required.
How We May Use or Disclose Protected Health Information
Following are examples of uses and disclosures of your protected health information that we are permitted to make. These examples are not meant to be exhaustive, but to describe possible types of uses and disclosures.
Treatment—We may use and disclose your PHI to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that is involved in your care and treatment. For example, we would disclose your PHI, as necessary, to a pharmacy that would fill your prescriptions. We will also disclose your PHI to other healthcare providers who may be involved in your care and treatment including training of medical students and residents.
Special Notices—We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment. We may contact you by phone or other means to provide results from exams or tests and to provide information that describes or recommends treatment alternatives regarding your care. Also, we may contact you to provide information about health-related benefits and services provided by our office or suggested by a health insurance plan. You will have the right to opt out of such special notices, and each such notice will include instructions for opting out.
Payment—Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as, making a determination of eligibility or coverage for insurance benefits.
Healthcare Operations—We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes, but is not limited to business planning and development, quality assessment and improvement, medical review, legal services, auditing functions, and patient safety activities.
Health Information Organization—The practice may elect to use a health information organization, physician's organization or other such organization to facilitate the electronic exchange of information for the purpose of treatment, payment or healthcare operations.
To Others Involved in Your Healthcare—Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person, that you identify, your PHI that directly relates to that person's involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your general condition or death. If you are not present or able to agree or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is necessary will be disclosed.
Other Permitted and Required Uses and Disclosures—We are also permitted to use or disclose your PHI without your written authorization for the following purposes: as required by law; for public health activities; Michigan Childhood Immunization Registry; health oversight activities; in cases of abuse or neglect; to comply with Food and Drug Administration requirements; research purposes; legal proceedings; law enforcement purposes; coroners; funeral directors; organ donation; criminal activity; military activity; national security; worker's compensation; when an inmate in a correctional facility; and if requested by the Department of Health and Human Services in order to investigate or determine our compliance with the requirements of the Privacy Rule.
Prohibited Uses/Disclosures - Substance use disorder treatment records received from Part 2 programs, or testimony relaying the contents of such records, will not be used or disclosed in any criminal investigation, to initiate or substantiate criminal charges, or in civil, criminal, administrative or legislative proceedings against you without your authorization or a court order with accompanying subpoena or similar legal mandate compelling disclosure.
PHI that is potentially related to reproductive health care is prohibited from being disclosed for purposes of investigating or imposing liability on any person for the mere act of seeking, obtaining, facilitating, or providing lawful reproductive health care.
Attestation - Any person requesting disclosure of PHI potentially related to reproductive health care for purposes of health oversight, law enforcement, judicial or administrative proceedings, or about decedents to coroners or medical examiners will be required to submit an attestation signifying that the PHI will not be used for prohibited purposes (see above section).
Privacy Complaints
You have the right to complain to us or to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated by us.
You may file a complaint with us by notifying our Compliance Officer at (616) 957-5165 extension 318 or officemanager@foresthillspediatrics.com. We will not retaliate against you for filing a complaint.
Vaccine Policy
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 patients of 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 American Academy of Pediatrics (AAP).
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.
If you would prefer to vaccinate your children with an alternate schedule or forego vaccinations altogether, we will ask that you seek care at a practice that aligns more with your beliefs.
If your child has received a vaccination at a pharmacy please notify our office so we can assure our records reflect the vaccination. Sometimes there is a delay in receiving notification from the pharmacy so we want to assure our records are as up-to-date as possible.
No Show Policy
Missed Appointments and Cancellations
Missed appointments are costly to us and to other children who could have used the time set aside for your child.
Cancellations are requested 2 hours in advance. This will allow us time to give the appointment to another child who needs to be seen that day.
We reserve the right to charge you $40.00 for missed or “no show” appointments as well as late cancellations made without 2 hours prior notice. New patients that “no show” for their first scheduled appointment will be discharged and will not be allowed to reschedule in our office.
Our “no show” policy states that after 3 “no shows,” your family will be discharged from our practice.
Parent Communication Policy
In most cases, a parent must provide consent to allow medical care to be provided to their minor child(ren). When parents disagree about their minor child's medical care, the question of who can make decisions on behalf of the child or who can access their medical records can be unclear. To prevent communication problems from impacting our ability to care to your child(ren), we have adopted these guidelines:
- You should provide us with any legal documents that describe the ability to make medical decisions on behalf of your child(ren).
- If there is a change in parental rights or authority in making medical decisions, please provide us with a copy of the legal documentation. Our practice does not interpret parental custody agreements. Therefore, we will not settle disputes between parents regarding any legal documents.
- If you cannot provide legal documentation, both biological parents will have access to the minor’s medical record.
- We will not consult with your child’s other parent about health decisions unless we are legally required to do so.
- Conflict over medical care must be settled between the parents. If parents disagree over vaccines or other treatments, we will follow the wishes of the parent who is present and consents for treatment at that visit. We will not contact the other parent to verify these choices.
- Our practice will not notify a parent when an appointment is scheduled by a different parent. We will contact the parent who brought the child(ren) to the appointment for any follow-up test results. We may try to contact the other parent if the parent who was at the appointment is not reachable.
- We will not be involved in custody disputes between parents unless we suspect abuse, neglect, or danger to the child(ren). Our providers will follow state laws about reporting such issues to the proper authorities.
- We do not write affidavits that name one parent as the "better" parent.
- We do not testify in court without a subpoena and/or depositions.
- If disagreements between parents make it hard for us to get consent or to care for your child(ren), our practice has the right to end the physician-patient relationship.
Virtual Visit Policy
We advocate for safe driving practices and do not condone distracted driving. For this reason, we insist that virtual visits do not take place in a moving vehicle. If you are in a vehicle please plan to be parked during your visit. If you do not comply, we will discontinue the privilege of virtual visits for your family. Thank you for your cooperation.
