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Our Pediatricians
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842 Altos Oaks Drive
Los Altos, California

P: (650) 941-0550
F: (650) 941-6751

Altos Pediatric Associates
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Financial Policy

Registration: Upon your first visit, you will be asked to fill out a patient registration form. We will ask you to review the information annually and complete a new form every three years. Please notify us immediately of any change in your address, phone numbers, etc.

Insurance Information: Please bring your insurance card with you to each visit. A copy of your insurance card will be kept in your chart. If your insurance changes, please notify us immediately.

Health Insurance Plans: Altos Pediatrics contracts with all the major PPO's such as Aetna, Blue Cross, Blue Shield, Cigna, Great West, Guardian, HealthNet, Principal Mutual, United HealthCare, etc. to name a few. WE ARE NOT CONTRACTED WITH ANY HEALTH MAINTENANCE ORGANIZATIONS (HMO'S) OR MEDI-CAL.

Your individual plan is an agreement between you and your insurance company. It is necessary for you to know the specific details of your own plan. We strongly recommend that you make every effort to understand your insurance coverage and the provisions of your particular plan. Please contact your insurance carrier prior to receiving services and scheduling appointments to verify your coverage (such as coverage and/or benefit limits for preventative care) and copay, deductible, etc. It is especially important for you to notify us if there are restrictions on referrals to specialists and outside facilities, including labs, for services. You may be liable for full fees from those outside providers if they are not contracted with your plan.

Copayments: It is our contractual responsibility to collect your copayment at the time of your visit and your responsibility to pay the copayment upon checking-in for your appointment.

Balances and deductibles: Our office bills most insurance companies for our patients. We will bill you for any portion of your visits that your health insurance company assigns as your responsibility. It is your responsibility to promptly pay this portion of your bill in full. If you are not able to remit full payment, please contact our billing office immediately to make payment arrangements. If we do not receive payment in full and are unable to do so within a reasonable amount of time and with reasonable notice, your account may be sent to collections. Failure to address your financial obligations with us may result in dismissal from our practice.

Self pay patients: For those families without insurance coverage, payment in full is required at the time of your visit. For your convenience, we accept personal checks, Visa, MasterCard and American Express.

Missed Appointment Fees: A missed appointment creates a hardship on our ability to ensure proper continuity of medical care for all of our patients. Courtesy reminders are made to you two business days in advance of your scheduled appointment. We require at least 24 hours in advance for cancellation of a preventative care visit. If we do not hear from you 24 hours prior to your appointment or you simply do not show up, a "missed appointment fee" will be charged to your account in the amount of $30, to cover the unfilled appointment slot. This fee is not billable to insurance and is your responsibility to pay.

Forms: We currently do not charge for the completion of school, camp, sports or other forms if we are given five to seven business days for turnaround. If you require completion of a form in less than our customary time frame, there will be a $20 service charge. You are responsible for payment in full at the time of form pick-up. The fee is not billed to your insurance company.

Urgent Care Saturdays/Holidays: While our regular office hours are Monday through Friday, we are open for URGENT CARE ONLY on Saturday mornings and certain holiday mornings (President's Day, Friday after Thanksgiving, Christmas Eve Day and New Year's Eve Day). Saturday and half-day holiday office hours are reserved strictly for seeing children in need of urgent care. There will be an additional fee charged for "urgent care" services provided on these days. These fees will be billed to your insurance company but we cannot determine whether or not they are covered and will be paid by insurance. You may be responsible for paying these charges.

After Hours Advice: Our office provides free medical advice from licensed registered nurses during regular office hours. Our after hours advice nurse provider (Night Nurse) charges our office for each after hours phone call.

We hope this policy helps clarify your questions. If you are unsure about the rules governing your insurance plan, please contact your benefit office or insurance company directly. You may call and speak to our billing office at any time regarding your account.

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