Financial Policy

For Registration

We’ll need the following items and information:

• Insurance card;

• Name, date of birth, and address of the plan member;

• Patient’s address and date of birth;

• Contact phone numbers for all parents and/or guardians.

Health Insurance Cards

When scheduling each appointment, our team will verify your insurance information. Our office staff will verify your eligibility prior to or at check-in for each appointment. If your insurance information changes, please notify us as soon as possible. Please bring your card to every appointment.

Health Insurance Plans

Because we participate with many different plans, we can’t know the provisions of each patient’s policy. We do recommend that you make every effort to understand your insurance coverage and, if necessary, to contact your carrier before receiving services, so you can verify your coverage levels (such as those for preventive care), co-pay, deductible, and co-insurance responsibilities. You are responsible for payment for any services not covered by your insurance.


We’re contractually obliged to collect, and you’re responsible to pay, your co-payment at the time of your visit. Please have your co-payment ready at check-in. If you don’t pay your co-payment at the time of service, we’ll need to add a fee (currently $10) for the cost of billing you.

Missed Appointments

Please confirm or cancel your appointment (online or by calling us) one day before your scheduled appointment time, doing so, will enable other patients to have an appointment. We change any unconfirmed appointment to walk-in (will be seen based on availability). Multiple missed appointments, or failure to comply with other Pediatrics R US / Eatonton Pediatrics policies, may result in dismissal from the practice.

Balances & Deductibles

We are responsible, by the terms of our contracts with health insurance companies, for billing you for any portion of assessment and treatment that your health insurance carrier does not pay and assigns as your responsibility. You are responsible for paying this portion of your bill.

Late Fees / Collections

If you don’t make full payment (or call to set up a payment plan) within a reasonable time period, you will be charged a $15 late fee. If your account maintains an open balance, it may be sent to collections and subject to an additional collection fee for per each applicable date of service. We may also pursue legal action to obtain payment. If you’re having difficulty meeting medical bills, please let us know. We’ll be happy to help you by setting up a payment plan. We encourage our patients to take advantage of this option, as we may have to dismiss from our practice patients who fail to meet their financial obligations.

Returned Checks

If you pay by check and your check is returned for insufficient funds (NSF), you’ll be responsible for the amount of the check, plus a returned check fee of $25. If more than one check is returned in any given period, we reserve the right to require all future payment by cash or credit card to prevent those situations from recurring.


The cost of researching, filling out, and signing forms is not covered by health insurance programs. We charge a nominal fee to cover the costs of completing these forms. The fees and processes are posted on our web site and may change from time-to-time.


The parent or guardian who signs the patient’s paperwork is the party responsible for all charges and payments. Due to confidentiality laws, we can only bill the person who signs the practice paperwork. Therefore, if the person responsible for the medical bill changes, the new guarantor must fill out a new set of paperwork. If your payment circumstances change, please inform us right away.

Self-Pay Patients

If you don’t have health insurance, we’re out-of-network for your particular insurer, or you’re receiving a non-covered service, payment at the time of the visit is required. For out-of-network plans, we’re happy to submit a claim to your carrier on your behalf.

Pay my bill with a check

(Check payable to “Eatonton Pediatrics”)

   Eatonton Pediatrics 

   PO Box 3009

   Eatonton, GA  31024