Please arrive on time for your childs appointment. If you arrive 10 minutes late, we may have to reschedule your appointment.
Haywood Pediatrics' Sliding Fee Discount Program
Haywood Pediatrics offers a Sliding Fee Discount Program to provide essential services regardless of the patient's ability to pay. Discounts are offered based on family size and annual income.
To see if your family qualifies, we will need the following from you:
A completed application.
Requested documents: Driver's License, utility bill, employment ID, prior year tax return, three most recent pay stubs.
Decisions are only made on family size and income.
The application must be renewed annually. If the family fails to pay, they are subject to normal office procedures for collection of debt.
For questions or more information about this program, please call 828-452-2211 ext. 1117.
Please click the link below to print and fill out the application. You can fax this into 855-732-4561 or bring to the office. If you need a paper copy, please call the number listed above.
SCHOOL NOTE POLICY
School notes will ONLY be issued for the date the child is seen. The parent/guardian may send a note for any additional days they are absent. Our purpose in providing a school note is to state that your child has been seen at our office. It is not meant to document length of illness or when a child can return to school. HIPAA privacy laws restrict disclosure of specific diagnosis information without written permission from the parent/guardian. School notes will be faxed to the schools; we can also supply a printed copy to the parent/guardian as a work note, if needed.
CONSENT FOR TREATMENT
For a child to be seen in either office whoever brings them to the office MUST be listed on the demographic sheet, have written permission, or have a consent for treatment document. We can no longer accept verbal consent.
18 YEARS AND OVER POLICY FOR CONSENT:
After someone reaches age 18 they are responsible for their own consent. The parent can no longer consent to treatment or obtain information, or ask that it be released to anyone else. In simple terms, the 18+ year old has to sign all legal documents. We must have written permission from the 18+ year to speak with their parents to share information with them such as for interview purposes, or to offer results.
APPOINTMENT POLICIES
Parents may schedule their child's routine appointments with the provider of their choice. They may also request a specific provider for sick visits. The provider given is dependent on schedule availability and parental convenience. We do our very best to accommodate each family.
New Parents: If you are about to become a new parent, we encourage you to make an appointment to meet us. There is no charge for this prenatal visit.
New Patients: Please come 15 minutes early to fill out necessary information forms.
- Please bring your child’s immunization record.
- Please bring all your child's medications or a complete list of your child's medications to EVERY appointment. This includes; prescription medicines, over-the-counter medicines, herbal medicines and vitamins and supplements.
- Sick or injured children will be worked into the schedule as soon as possible.
- If your child is seriously ill or injured, please alert our staff immediately.
- Please communicate with our staff if you feel your child’s visit will require more than the usual amount of time. Examples of this include serious behavioral problems, premature infants, gynecological exams, or any child who has a chronic illness or disease.
- Please call us to cancel appointments you do not wish to keep.
- When one of your children has an appointment, please do not bring other children to be seen unless you have notified us first. Each child will have a separate visit and an additional appointment time is required. There will be a charge for each child seen.
- School, camp, and sports physicals need to be scheduled well in advance. This is especially important at the beginning of a new school year. Please bring all your forms with you and fill out as much as you can at home.
- If you are more than 10 minutes late for your appointment please check with the assistant at the check-in desk to see if the practitioner can still see you. We can rarely see patients who are more than 10 minutes late for an appointment.
- If you have waited more than twenty minutes after signing in, please notify one of our staff.
- NO-SHOW POLICY: Please, if you cannot keep an appointment, call and cancel. We prefer that you call 24 hours in advance to cancel. It is the policy of the office that you may be dismissed from the practice if you have more than two no-shows in a one year period.
Vaccine Policy
- Click HERE for our vaccine policy.
BILLING POLICIES
Thank you for considering to choose our practice, We are committed to assisting you with your insurance and financial obligations. We accept insurance assignment, cash, checks, Visa and MasterCard.
Please read our financial policy below:
Haywood Pediatrics is committed to caring for the children and youth of Haywood County and providing excellent care to sick children regardless of their financial situation. To assist you, we have the following policy. If you have any questions, please speak with a member of the staff.
Unless other arrangements have been made in advance by either you or your health coverage carrier, full payment is due at the time of service. We accept Cash and Credit/Debit Cards.
We expect timely payment for our services but are willing to discuss payment plans for the parents of sick children who are experiencing economic hardship.
Haywood Pediatrics has a Sliding Fee Discount Program in place for families who qualify. The program is designed to provide free or discounted care to those who have no means, or limited means, to pay for their medical services. We'll be glad to talk to you about this program.
Payment is expected at the time services are rendered.
- The adult (parent/legal guardian) who signs the demographics will be considered the guarantor and will be responsible for the bill. We cannot be responsible for arrangements between divorced parents and other custody arrangements.
- All insurance co-pays are to be paid at the time of service. Uninsured patients will be offered a discount for paying in full at time of service.
- We expect regular payments (at least every 30 days) on outstanding balances and the patient representative is responsible for setting up payment arrangements with Haywood Pediatrics. Failure to do so may result in your account being referred to a collection agency and your family’s termination from the practice.
- Uninsured/Underinsured patients scheduled for a wellness visit, medication appointment or birth-control appointment there will be a deposit required at check-in.
Insurance
(Please present patient’s insurance card at each visit)
As a courtesy, we will file claims for all visits. However, payment is expected at the time of service for co-pays, deductible amounts, etc. and it is the responsibility of the patient representative to verify with the insurance that we are participating with their policy and to know what benefits are covered under that policy. We participate with NC Medicaid Direct and all the NC Medicaid PHPs, Aetna, BCBSNC, Cigna, Crescent, Medcost, Partner's Direct Health, Tricare, United HealthCare . Health Insurance Marketplace Plans: CareSource, OSCAR & United Health Care. If you don't see your plan listed, please ask if we participate in-network.
Site User Policy:
In case of an emergency, do not post a message. Instead, please call 911
We encourage you to leave comments; however, we will review comments and will remove any that are inappropriate or offensive at our discretion.
The comments posted on this site ("User Content") do not necessarily reflect the opinions or ideals of Haywood Pediatric & Adolescent Medicine Group, PA ( hereafter referred to as Haywood Pediatrics), its employees or affiliates.
For purposes of these Rules, the term “User Content” also includes any photos, videos, music or any other materials or content.
Messages posted to our sites and the content therein are not encrypted or secured by other means, and are available for unlimited viewing and printing. You are solely responsible for the content of your postings.
Haywood Pediatrics and the employees, affiliates and agents thereof are not responsible for any claims, damages, losses, liabilities, costs or expenses that directly or indirectly result from your use of your posted message content.
Haywood Pediatrics disclaims responsibility for defamation, obscenity or any Message Board content that may be considered inappropriate
Before posting on the site, you agree to comply with Haywood Pediatrics Terms of Use;
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- Third-party links may be deleted, and self-serving posts will be blocked;
- When posting messages, keep discussion as close as possible to the topic at hand;
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- Publishing of another person’s personal information without permission is prohibited and you are solely responsible for such content;
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You grant Haywood Pediatrics a royal-free and fully-paid license to use and display the User Content throughout the world in any type of electronic or digital media for marketing and/or public relations purposes in perpetuity.
You consent to allow Haywood Pediatrics to contact you through email (or as otherwise indicated by you) regarding any request Haywood Pediatrics may have related to obtaining permission from you to use the User Content.
You agree to bring complaints and concerns to the attention of Haywood Pediatrics before discussing them in the community or online.
OCR NOTICE Of Nondiscrimination
Source: HHS Office for Civil Rights
Haywood Pediatric and Adolescent Medicine Group, PA
complies with applicable Federal civil rights laws and does not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity, or ability to pay.
Haywood Pediatric and Adolescent Medicine Group, PA
does not exclude people or treat them differently because of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity, ability to pay
Haywood Pediatric and Adolescent Medicine Group, PA
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Provides free language services to people whose primary language is not English, such as:
If you need these services, contact Name of Civil Rights Coordinator.
If you believe that Haywood Pediatric and Adolescent Medicine Group, PA, has failed to provide these services or discriminated in another way on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity, ability to pay, you can file a grievance with:
Chris Henson, Business Manager
15 Facility Drive
Clyde, NC 28721
Phone: 828-452-4421 ext. 1110
Fax: 855-732-4561
You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Chris Henson, Business Manager is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/loggy.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue SW
Room 509F, HHH Building
Washington, DC 20201
Toll Free: 1-800-868-1019
800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Haywood Pediatric and Adolescent Medicine Group, PA, complies with applicable Federal civil rights laws and does not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity, ability to pay.
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