Home | Resources | Policies & Forms

Thank you for choosing Premier Pediatrics for your child’s primary medical needs. Prior to your first visit, take some time to read and become familiar with our practice policies . If you have any questions, feel free to contact us at info@premierpediatricsny.com.

Policies

Premier Pediatrics strongly enforces our 20-Minute Rule. If you arrive more than 20 minutes after your scheduled Well Child Appointment, we reserve the right to reschedule your appointment. We have implemented this policy to help our physicians stay on schedule. Please be courteous to those who are scheduled after your visit by arriving on time.

Cancellations: We ask that you call us as soon as possible to reschedule your appointment. A $25 fee will be charged for all same day cancellations and no-shows. The fee will be $50 for lactation and nutrition appointments.

Thank you for making an appointment with our nutritionist. Please note that this visit will be billed to your insurance company and may incur a copay or deductible as per your policy.

Our staff nutritionist only works one day a week, therefore the appointments are limited. We understand that there are times when you must miss an appointment due to emergencies or obligations for work or family. However, when you do not call and cancel an appointment, you may be preventing another patient from getting much needed treatment. If you need to cancel this appointment, advance notice of 48 hours should be given. If an appointment is not cancelled at least 48 hours in advance you will be charged a fifty dollar ($50) fee; this will not be covered by your insurance company.

Co-pays

We request that an insurance card is presented at each visit. All co-payments and past due balances are due at time of check-in unless previous arrangements have been made with a billing coordinator. We accept cash, check or credit cards. No post-dated checks will be accepted.

Accepted Insurance

  • 1199
  • Aetna (no Community Plan or NY Signature)
  • Allied Benefits System
  • Beech Street
  • Blue Cross/Blue Shield (Pathway,Gatekeeper all colors,etc) NO Blue Priority
  • Blue Cross Family Health
  • Cigna PPO/POS
  • Consolidated Health Plan
  • Coresource Direct Guild of America
  • Emblem Health
  • NO HMO 6300S
  • NO 35/55S
  • NO 40/60S
  • No color plans (Bronze, Silver, Platinum)
  • No Healthy New York, HMO 15/35
  • No select care D or POS w/color
  • Empire Plan
  • First Health
  • GHI (no HMO)
  • Golden Rule
  • Great West
  • Guardian
  • Healthnet
  • HIP Prime
  • Horizon
  • Humana
  • MagnaCare
  • Meritain Health
  • Multi Plan
  • MVP
  • Nippon Life Insurance
  • Olympus
  • Oxford (no Metro)
  • Pacificare
  • PHCS
  • Pomco
  • Screen Actors Guild
  • Trustmark
  • Tufts Health Plan
  • UMR
  • United Healthcare (no Compass )
  • Only Plans that we accept off the Exchange ( Emblem health Child Health Plus, Blue Cross BlueShield all colors)

WE DO NOT ACCEPT ANY FORM OF MEDICAID.
* If you’re still unsure, contact your health insurance and give them our Tax ID#13-3796742 to determine if we are in your provider’s network.

There is no charge for a single set of medical records. Any additional copies will cost $.75 per page. If you are leaving the practice, we suggest that you pick up the records. Premier Pediatrics cannot be responsible for claims that the records have not reached the destination. To guarantee receipt of records, we advise our patient’s families to pick up the records themselves.

Premier handles the majority of screening labs in our offices. Infrequently, we send patients to outside labs. When possible, we recommend that you use the following centers:

The charge for a returned check is $30 payable by cash or money order. This will be applied to your account in addition to the insufficient funds amount. You may be placed on a cash-only basis following any returned check.

Thank you for making an appointment with Premier Pediatrics lactation services. When you and your baby are being seen by the lactation consultant, you will also be registered as a patient of our practice. This is because the lactation consultant will be making medical recommendations for both of you. We will attempt to bill your insurance company for your portion of the visit. In the event your insurance does not cover this service, Premier Pediatrics will only charge a $50 fee. Depending on your child’s insurance plan, you may also be responsible for any co-payments, deductible, and/or co-insurances.

Patient Forms

We have compiled a hard copy of Premier Pediatrics’ policies. We ask that all new families read New Patient Agreement Form and sign it at their first visit. It contains descriptions of our appointment, insurance, financial, and referral forms, and prescription re-fill policies.

Premier Pediatrics requires a full copy of your child’s medical records including any completed lab work and all vaccine records. A child patient cannot be registered without the required records. We recommend you request your records from your current pediatrician and bring them with you for your first appointment. In that way, you will know the status of your child’s chart.

Physical exams for school or camp forms are valid for one year. If your child has not had a physical within one year, schedule a well visit as soon as possible. April through September is a hectic time for physical exams, so schedule an appointment as quickly as possible.

There is a $20 annual form fee. The form will be ready within one week from the requested date and can be picked up or sent by mail. We DO NOT fax forms.