PAYMENT POLICIES

Self-pay clients: I will provide you with a superbill suitable for you to submit to your insurance. The superbill (which will also serve as a payment receipt) will be coded appropriately to the level of service provided during the visit. You agree to pay me $375 at the time of the visit (cash, check, credit card, or FSA). If the total fee for the visit is greater than the self-pay charge, I will not bill you for that balance. You agree that any fees paid by your insurance over and above the self-pay charge will be paid to me, either directly from your insurance or from you if your insurance sends you more than the self-pay fee. Follow up visits receive a $100 discount.

Aetna clients: I am in-network with Aetna, which means I will submit your fees for Aetna’s consideration. Aetna’s usual and customary allotment for each procedure will satisfy your account; ultimately, each client remains responsible for full payment for services. If Aetna applies any portion of the fees to deductible or coinsurance, you will be invoiced for the applied charge. If any portion of your baby’s claims are applied to deductible or coinsurance, you will be invoiced for those charges. If your baby is not on your Aetna plan, you agree to pay $60 for the initial visit and $40 for the first follow up. You are responsible for providing me with accurate insurance information and informing me of any changes in your insurance status; if you do not have coverage at the time I see you, you will be responsible to pay me at my self-pay rate. PLEASE NOTE: Due to CVS taking over Aetna, there is a possibility that the claim filed for your baby will be subject to cost sharing. In that case the amounts would be approximately $60 for the first visit and $40 for the first follow up.