Thank you for choosing Millcreek Pediatrics! We are committed to providing you with quality and affordable health care. Our practice adheres to the guidelines outlined by the American Academy of Pediatrics, the Centers for Disease Control and conforms to the standards required by the Insurance industry.

  • Please review this financial policy statement, ask any questions you may have, and sign in the space provided. A copy of this document will be provided to you upon request.
  • Every patient or legal guardian must complete a registration form each year and allow us to copy a valid driver’s license and a current, valid insurance card. Electronic confirmation of insurance eligibility is performed prior to every office. It is your responsibility to update us with any changes in your insurance at the time of your office visit. If you are insured by multiple plans, you are responsible to provide ALL insurance information for every plan.
  • INSURANCE- Millcreek Pediatrics participates in many insurance plans. Please confirm with our staff to check if we are “in-network” for your individual plan. We do not have access to the specific reimbursement details of your plan. Having knowledge of your insurance benefits is the patient’s responsibility. If you have questions about the details of coverage for vaccinations, office testing, laboratory evaluations or procedures, contact your insurance company prior to a service being performed.
  • In the event that we do not participate with your medical insurance plan or if you do not have an up to date insurance card, full payment will be required at the time of your visit. Likewise, if electronic confirmation of eligibility is not valid/active, full payment will be required at the time of your visit.
  • PAYMENT FOR SERVICES- All co-payments required by your insurance company are due at the time of service. Millcreek Pediatrics will mail a statement to you after each visit (once processed by your insurance) explaining any fees assigned to you by your insurance. Any outstanding balance in excess of 30 days must be paid prior to obtaining additional service.
  • Returned checks are subject to a $35.00 service charge (in addition to any bank fees).
  • CLAIM SUBMISSION PROCESS- If we participate with your insurance plan, we will submit a claim to obtain payment. Your insurance company may need additional information from you. You must supply this information directly to them. Failure to comply will result in denial of your claim, and you will be billed the full expense of the office visit. After each visit you will receive an “Explanation of Benefits” (EOB) from your insurer outlining the details of payment for specific date(s) of service. This EOB is used by us to determine if all or a portion of each service has been assigned by the insurer to you for payment. Depending on the details of your plan, you may be responsible for the following: required vaccines, “in-office” testing, procedures, as well as deductibles, coinsurance and certain types of non-covered office visits. Please be aware that even office procedures monitored by your insurance (Quality of Care measures) may result in assignment of a fee to you by your insurer.
  • AGING OF ACCOUNT BALANCES- For each office visit, a remaining balance assigned to you by your insurer will initiate a billing statement from Millcreek Pediatrics. This statement must by paid in full within 30 days. Refer to your EOB to confirm the assigned balance. A balance not paid within 30 days of an initial statement is considered “past due”, and a ten dollar processing fee will be added. Each subsequent “past due” statement will incur an additional ten dollar processing fee which will be cumulative ($30.00 dollars at 90 days).
  • Families with a PAST DUE account balance will not be able to schedule an appointment. At 120 days from the initial statement, any unpaid balance (including processing fees) will be forwarded to a collection agency and a 25% collection fee added to the total. Once forwarded, the family (all members on the account) is discharged from Millcreek Pediatrics.
  • APPOINTMENT CANCELLATION- We require 24 hours notice for cancellation of your child’s appointment. Missed appointments, “No Call/No Shows” or cancellations with less than 24 hours notice will be subject to a $50.00 missed appointment fee. This charge is your responsibility, and it will be billed directly to you. This fee must be paid in full prior to scheduling an appointment. If a family (all persons on account) has 4 missed appointments with our practice, the entire family will be discharged from our practice.
  • APPOINTMENT LATENESS- Patients arriving after their scheduled appointment time will be considered late for their appointment. Due to our busy schedule, a patient who arrives after their appointment time may not be able to be seen. If a patient arrives more than 15 minutes past their scheduled appointment time, the appointment will be considered and counted as a “No Call/No Show”.
  • FORMS- There is a $10.00 charge for any forms (for example: physical, school, daycare, FMLA, etc.) not presented at the time of the physical. There is a $25.00 charge for all Letters of Medical Necessity. All forms require 7 business days to complete and 14 business days for Letters of Medical Necessity, due to their complex nature.
  • TRANSFER OF RECORDS- There is a $30.00 charge for transfer of medical records. Any outstanding balances must be paid in full prior to the transfer of medical records.
  • DEVICES- No audio, video or recording devices are allowed in our practice without expressed written consent from Dr. MacFarlane and/or Dr. Seiff.
  • The patient/guarantor has the responsibility to inform Millcreek Pediatrics if the patient’s contact information changes, i.e. phone number, address, insurer, etc.
  • If you have general questions about your insurance, our Billing Department will assist you. However, specific insurance questions related to your insurance coverage or charges must be directed to your insurance company’s member services department at the phone number specified on your insurance card).
  • Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area. Our financial policy is subject to change at any time without notice. 

Office Financial Policy