top of page

CONFIDENTIALITY:  Confidentiality of ALL personally identifiable information has long been the standard in the medical profession, and the government has set laws to enforce similar standards to protect confidentiality.  We will not and are not permitted to give information to anyone other than the registered patient or their legal guardians. We are sorry for any inconvenience because this does include, but not limited to, parents of patients 18-21 years old or emancipated patients, grandparents, aunts, uncles, friends, and babysitters unless there is a written release signed by the patient or legal guardian.  Information given to us by you is protected from disclosure EXCEPT when required by law to be disclosed.


SCHEDULED VISITS:  Scheduled appointments are necessary. Preventive care visits can be referred to as well checkups, well child checks, physicals, or sports physicals. Acute sick visits are typically scheduled same-day and in order of time availability.  We do our best to stay on time so both parties can plan and not waste valuable time. When you are scheduling appointments, please make our scheduling staff aware of ALL specific symptoms or concerns you would like addressed.  By doing so the appointments can be scheduled appropriately and we can maintain a timely schedule for you and other patients waiting to be seen. It is your responsibility to know what day and time your appointment is scheduled and it is expected that you arrive in the office on time.  If you are running more than 10 minutes late for an appointment, we will try to work you back into the schedule, offer you an appointment with a different provider or at a later time, or, in some instances, out of courtesy to the other patients, we will ask you to reschedule the appointment to a different day.


MISCELLANEOUS APPOINTMENTS & CANCELLATIONS:  It is necessary to have a policy in place regarding “no-shows” and cancellations. Following this policy will help allow us to continue practicing without unnecessarily shortening visit times or increasing costs.  A “no-show” is considered an appointment that is missed or not cancelled at least 4 hours before the appointment. We will attempt to make appointment reminder calls to the first listed phone number in the chart; however, they are a courtesy, not a requirement and should NOT be depended upon. It is your responsibility to know what day and time your appointment is scheduled.  After the both first and second “no-show” we will mail a letter to remind you of our policy.   A third “no-show” may regretfully cause us to dismiss the patient from our practice.   If that should happen, you will be notified by certified letter; after notification of dismissal, we are required by law to be available to the patient for 30 days for non-routine concerns.  For a new patient (never been seen in our office), this process is accelerated.  The first no-show, you will be informed of our policy and if a second no-show occurs, we will not accept you as a patient.


PHONE CALLS:  Our office receives many calls each day, many of which require direct and immediate communication with a doctor. We have nurses available during the day to help you. They are trained to follow pediatric protocols that have been previously discussed with the doctors. They are also in communication with the doctors throughout the day.


HEALTH/PHYSICAL/SPORTS PE/ FORMS:  Due to the high volume of requests we get for health form completions, we require 5-7 days to complete each form.

  • All areas for parent/patient completion MUST be filled out before we can complete the form.

  • Your child must have a current physical/checkup completed by one of our providers before the form can be completed. We cannot fill out the form until a current physical is on record; therefore, you may be asked to schedule a physical appointment.

  • If your child/adolescent has had an annual checkup in our office within the last year, their sports physical form can be completed.

  • There is no charge for completion of the form.


PRESCRIPTION REFILLS:  Due to the volume of requests for medication refills, we have a voice mail set up specifically for these requests.  When calling our office for a medication refill, please allow 3-5 days for the request to be completed.  Medication refills are not routinely called in to pharmacies during appointment hours so that the doctors may take all appointments as scheduled.


INSURANCE COVERAGE:  Pediatric Consultants of Ashland and Mansfield accept most types of insurance. The terms of insurance coverage are entirely your responsibility.  We may try to obtain as much information as needed from your insurance company to bill for our services, but you will need to communicate with your insurance carrier directly when attempting to determine the coverage provided by your specific policy.  You must refer to your printed materials and service phone numbers that your insurance carrier has provided you for coverage determination information. We do NOT have access to the Summary of Benefits that your plan provides.

  • Routine health checks include services that may or may not be covered as a separate charge depending on your plan. (For example: vision & hearing screening, urinalysis, and vaccines & administration fees associated with vaccines may carry a separate co-pay from your office visit co-pay)

  • X-rays and Labs recommended or ordered by our physicians and not done in our office may or may not be covered by your insurance carrier plan. You will be responsible to know the written extent of your plan. Pediatric Consultants of Ashland and Mansfield is not responsible for services not performed in our office.

  • Office visit co-pays are due at the time of service. If they are not paid on the day of the visit, there will be an additional $5 fee. 


MEDICAID:  We gladly accept Medicaid. If you are a Medicaid recipient, you must:

  • Bring your current card to every visit.

If you fail to bring the current month’s card you can:

  • Keep your current appointment time and pay for the visit at the time of service and receive a discount as a self-pay visit.

  • Obtain your current Medicaid card and reschedule your appointment for a different time.


SELF-PAY (No Insurance):  Self Pay Discounts are applicable to self-pay accounts (no insurance) and only if the entire charge for the visit is paid in full at the time of service.

  • It is your responsibility to ask for the service charges and discounts available for certain service and product codes.


EMERGENCY & NIGHT/WEEKEND CALLS:  For our patients, our own doctors take after hours URGENT phone calls as a courtesy to you, so we can ensure you will receive the best possible care whenever needed.  The pager number is on our office telephone answering machine.  We recommend you call the office first to listen to the message because there may be occasional circumstances in which another number will be in use.


ESTABLISHED PATIENTS:  We expect all established patients to use our office for primary care and routine visits, such as wellness checkups/physicals, and routine illnesses or conditions. We require patients that are followed by our office for ongoing diagnosis to be current on their wellness checkups. We will also follow your insurance guidelines with regards to wellness checkups, which may require a routine wellness exam. Those patients who do not comply with this requirement may be dismissed from our practice.


TRANSFERRED PATIENTS:  There is a charge for the release of medical records to another care provider; there is no charge for a copy of the immunization records. If you transfer care from Pediatric Consultants of Ashland and Mansfield to another doctor for any reason and later want to re-establish care, you may not be permitted to re-establish care with Pediatric Consultants of Ashland and Mansfield.  Each request to re-establish will be considered once a written request to re-establish is received.


21 YEAR OLD PATIENTS: Our providers treat patients from birth to 21 years of age.  Once a patient turns 21 years old, they will no longer be able to be seen by our providers.  So as the patient approaches 21 years old, it is a good idea to begin the search for a primary care physician that treats adult patients, such as a family practice or internal medicine provider.


INAPPROPRIATE BEHAVIOR:  While on the premises of our office or during conversations with our office staff, if a patient or associated with the patient engages in inappropriate behavior, such as cursing, yelling, derogatory comments or throwing items, the patient and siblings may be discharged from our practice.


IF ISSUES ARISE: If you have issues or concerns you would like to discuss, our staff is willing to participate in courteous and polite communication in which both parties will be respectful of the other. We understand that illness takes its toll mentally and physically.  So, while we promise to treat you fairly, with courtesy, respect and understanding, we expect to be treated the same.  We want to exceed your expectations and the nature of our business necessitates flexibility from everyone involved for the best possible care.


Revised 9/26/2014

Policies & Procedures

For the best medical care, it is important we work together as a team from the beginning of our relationship. We want to give your family as much attention as needed to be healthy and safe.

bottom of page