Main: (678) 381-2630
Fax: (678)381-2627
Email: Admin@GraysonPediatrics.com
297 Cooper Road
Loganville GA 30052

Billing and Fees

Billing Policies

The following is a synopsis of Grayson Pediatrics’ billing and payment policies.

All co-payments are expected at time of service. For your convenience, Grayson Pediatrics accepts cash and Visa/MasterCard debit and credit cards. Surcharges will be assessed for returned checks or co-payments not made at time of service.

Our contracts with insurance require that we verify your current coverage and collect your co-pay at each visit. If your insurance plan requires deductibles and coinsurance, you will be required to pay a of minimum of $65 toward your patient responsibility and will be asked to leave a credit on file so we can charge the remaining patient responsibility after your payer returns the Explanation of Benefits.

Please bring your insurance card to every appointment. We will need to make a copy and verify your insurance at every visit.

Fees for non-covered Sevices

The following fees will be charged for services that are not covered by insurance:

SERVICE and FEES DESCRIPTION
No show/Missed Appointment Fees No show/missed appointments will be charged a $50 “No Show Fee” for each appointment missed. These fees are not covered by your insurance. To avoid such fees please attend all scheduled appointments on time (which is provided to you) or call our appointment line at least 24 hours in advance to cancel the appointment. All No show/missed appointment fees MUST be paid prior toscheduling your next appointment.
NSF Checks If your check is not honored by our bank we will assess an NSF processing fee, which you will be billed along with a $20 administrative fee to reprocess your payment.
Insurance re-filing If incorrect insurance information is given that requires a claim to be re-filed, there will be a $35 re-filing fee. This fee is not covered by your insurance.
Co-payment & Co- Insurance Co-payments & Co-Insurance are collected up front and are due at the time of service by the person bringing the patient for the visit. If you do not have your co-pay, we will bill you for a $20 administrative fee.
After Hours Services A $20 after hours fee will be billed to your account when a provider is contacted (phone, email, social media, etc.) and reached during non-office hours. This fee is notcovered by your insurance.
Health Forms We will provide your child with one health form for school (form 3300), certificate of immunization (Form 3231) or camp per year free of charge if given at the prevention visit. These forms requested outside of your child’s prevention visit will be assessed an administrative fee of $10 each.Due to the complexity and time spent on the following forms, a $50 administrative charge for each form indicated below will be assessed to your account:

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Walk-In Visits If you walk in without an appointment, you may be directed to the Urgent Care Facility or the Emergency Room. We work by appointment only. There will be a$50 convenience fee in addition to your copay for walk ins. Both your copay and$50 convenience fee will be due at the time of service.
Medical/immunization Records Requests If you need a complete set of your child’s medical records, there is a $25 administrative fee. Copies of your child’s immunization records are provided free of charge (if requested at the time of the prevention visit).
Third Party Medical Records Requests If a non-medical entity needs a complete copy of your child’s chart, we charge a feebased on Georgia medical record copying laws. If we refer you to a specialist for further treatment we will send a copy of your child’s chart free of charge.