Policies

Camelback Pediatrics is a vaccinating practice.

We recommend that all of our patients follow the recommended immunization schedule, and we stock these vaccines accordingly. We are also a practice that is sensitive to the concerns of families. Because of this, we pledge to work with families to assure that their concerns are addressed, as long as we can continue to protect our patients from diseases that may imminently threaten them and other patients with whom they are in contact.

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 CDC's National Center for Immunization and Respiratory Diseases(NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.

Furthermore, we firmly believe that by not vaccinating your child, you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that a child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable. Even delaying or “breaking up the vaccines” to give one or two at a time over additional visits goes against expert recommendations, is not supported by any scientific data, can lead to unnecessary delays and errors, and can put your child, other children, and adults at risk for serious illness (or even death). It is therefore against our medical advice as professionals at Camelback Pediatrics.

Payment for services, including copayment, co-insurance, and/or deductible amounts, is due at the time services are rendered unless payment arrangements have been approved by our billing staff. We accept cash, checks, MasterCard, Visa, Discover and American Express. Our failure to collect these amounts is a violation of our contract with your insurance company and may result in civil and criminal penalties and/or expulsion from your insurance plan. In addition, your failure to pay the required co-amounts is a violation of your financial responsibility for coverage and we may report your refusal to pay these amounts to your insurance company.

If you cannot furnish an insurance card at the time of the visit, you will be responsible for payment in full at the time of service. It is not the responsibility of our office to obtain this information for you. We will be happy to supply you with an accounting of the visit so that you may submit the information to your insurance company for reimbursement.

Returned checks will result in a $25.00 fee that will be posted to your account. Returned checks, balances older than 60 days, and failure to pay account balances as promised will be subject to external collection and additional collection fees, including attorney and other court fees. We may investigate your credit record to determine your ability to pay your debt.

We will gladly discuss your proposed treatment and answer questions relating to your insurance. Your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract. We must emphasize that as medical providers, our relationship is with you, not your insurance company.

Please be advised that if you are scheduled for a routine well visit, but also have health issues to have evaluated at the same time, we will need to bill your insurance for both the well visit code and the evaluation of the services OUTSIDE the scope of a routine physical.

We do require at least 24 hours’ notice for cancellation and rescheduling of any appointment. A $30.00 no show fee may be applied to your account for each missed appointment if you fail to arrive for your appointment. (e.g., two children scheduled at the same time will be charged $30 each for both missed appointments). If you have 3 no show appointments in a calendar year, you will be discharged from the practice. You will then have to plan to establish with a new doctor.

Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover. While the filing of insurance claims is a courtesy that we extend to patients, all charges are your responsibility from the date the services are rendered. We realize that temporary financial problems may affect timely payment of your account. If such problems do arise, we encourage you to contact us promptly for assistance in the management of your account.

Masks are no longer required for all visitors. However, as a courtesy to other patients and staff, we ask that you wear masks if you or your child have symptoms compatible with an infectious illness. These symptoms include fever, cough, runny nose or sore throat. Thank you.

Welcome to Camelback Pediatrics!

We are thrilled to have you choose us for your child’s medical care. Our mission is to provide your family with convenient, accessible, and high-quality healthcare. For more detailed information about our services and helpful resources for your child’s health and development, please visit our website at www.camelbackpediatrics.com.

Below are some important details and our Financial Agreement. Please review carefully and sign on the last page. By signing you are acknowledging and agreeing to these policies.

Appointments: We request that all patients arrive 15 minutes early for their scheduled appointments to allow our team time to complete necessary administrative tasks. Please bring a photo ID, insurance card, and a form of payment. If you need any paperwork for your appointment, the forms are available on our website under the "Forms" section. You will receive an automated confirmation via call, text, or email 1-2 days before your appointment.

Late Arrivals: Arriving more than 15 minutes late may result in your appointment being rescheduled.

Cancellations and No-Shows:  We kindly ask for 24-hour notice if you need to cancel or reschedule your appointment. For same-day appointments, we provide a 3-hour window to call to cancel. Failing to do so will result in a $50 Late Cancellation fee for well or sick visits, and $100 for mental health appointments. A "No-Show" will incur the same fees. Multiple missed appointments may result in dismissal from our practice.

Service Animals: Only certified service animals are allowed in the clinic.

Patient Portal: Our patient portal allows you to access shot records, pay bills, and request routine visits. You can access it via our website.

Well Visit with Additional Health Concerns: If additional health concerns are addressed during a well visit, your insurance may require a separate charge for the extra services, which may result in copays or other costs.

Medical Records: To request medical records, visit our website’s "Forms" page and complete the Medical Records Release form. Records will be processed within 3 business days. Fees may apply.

Divorce/Separation/Custody: Camelback Pediatrics does not engage in custodial or financial disputes between parents. The parent bringing the patient into the office is responsible for making any payments for the services provided. Both parents can access their child’s medical records unless a court order says otherwise.

FINANCIAL AGREEMENT: All payments, including copays, deductibles, and coinsurance, are due at the time of service. The individual bringing the child is responsible for payment. We accept cash, check, Visa, MasterCard, Discover, and Amex. Please review our Credit Card on File policy.

Insurance Benefits and Coverage: While we strive to verify insurance benefits, it is your responsibility to know your coverage and manage authorizations. Please ensure that your insurance card is available on each visit. Most payers have adopted a 90-day window from the time of service for our office to be able to file a claim. If we do not have the proper insurance information in that timeframe, you will be 100% responsible for paying all billed charges. Our office will not file claims outside the timely filing period.  

Newborn Coverage: Most plans require newborns to be added within the first 30-days. We will hold claims for the first 30 days to allow for the newborn to be added. During this time, we will treat the patient as active on the plan, collecting toward any copays, deductibles, and/or co-insurance amounts. It is vitally important that parents provide all available medical policies so our office can coordinate with the payers to determine eligibility, even if the newborn isn’t being added to all policies. Some payers will cover a newborn for the first 30 days, regardless of whether they are ultimately added.  

Non-Payment: Failure to pay your copay, deductible, co-insurance, or any past-due balance at time of service may result in a $10 fee being assessed to your account. We understand that circumstances may arise that make paying at time of service difficult. We ask that you speak with our billing department ahead of time so we can make any necessary payment arrangements.

Returned Checks: A $40 fee will be charged for returned checks, and future payments will need to be made via cash or credit card. HIPAA Notice: You have been offered the

HIPAA Notice of Privacy Practices, which explains your privacy rights and how your information may be used.

□ Yes □ No □ Offered but Declined Initials: __________

I have read and agree to the terms and conditions outlined above.

Parent/Guardian Name (Print): ______________________________________

Signature: _____________________________________________

Date: __________________