Patient Information
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Policies & Procedures
Financial Agreement / Policies
Financial Agreement
By receiving services at Pediaprogress, Inc., I acknowledge and agree to the following:
- Third Party Coverage
I will apply for and maintain eligibility for any third-party coverage I qualify for and agree to promptly transfer to Pediaprogress any reimbursements I or a dependent may receive.
- Authorization to Bill Insurance
I authorize Pediaprogress, Inc. to bill any responsible third party, now or in the future, for payment for all services provided.
- Co-Payment Policy
I agree to pay all established co-payments at the time of service. I understand that failure to pay may result in cancellation of therapy sessions, and continued failure may lead to termination of services.
- Assignment of Benefits
I agree that all insurance benefits for services rendered be made directly to Pediaprogress, Inc. If direct assignment is not possible, I agree to reimburse Pediaprogress within seven (7) days of receiving payment from a third party. I authorize Pediaprogress to contact third parties to verify or obtain payments.
- Claim Filing Cooperation
I agree to provide all necessary information to file insurance claims, including signatures, policy numbers, and third-party contacts.
- Claims Related to Legal Action
If I pursue a legal claim (e.g., personal injury or malpractice), I will pay Pediaprogress for all unpaid balances related to services rendered under that claim.
- Patient Responsibility for Non-Covered Services
I understand that I am financially responsible for any services not covered or denied by insurance, including services deemed medically unnecessary.
- Timely Payment & Late Fees
I agree to pay any outstanding balances within 30 days. A $5 late fee will be applied to balances over 60 days past due each month. Accounts in default may be sent to a collection agency. Returned checks will incur a $25 fee.
- Changes in Financial or Insurance Status
I agree to inform Pediaprogress immediately of any changes to my insurance coverage or financial circumstances affecting this agreement.
- Right to Terminate Services
Pediaprogress, Inc. reserves the right to terminate services at any time, without waiving the right to collect payment for services rendered. Reasons may include:
- Submission of false information
- Non-compliance with attendance or payment policies
- Breach of any terms of this agreement
Additional Policies & Procedures
Comprehensive EVALUATIONS:
Evaluations typically last 45 to 90 minutes, and a comprehensive written report is included in the evaluation fee. For families with non-contracted insurance companies, 50% of the evaluation fee must be paid prior to the appointment. The remaining balance will be invoiced along with the completed report. Please contact our office if you have questions about your insurance coverage or payment responsibilities.
TREATMENT SESSIONS:
Sessions are typically 30-55 minutes in length, including parent / caregiver consultation time. For younger children, caregivers are encouraged to stay in the therapy room during the session and to collaborate with the therapist.
TREATMENT PLANS (a list of goals) & RE-EVALUATIONS:
Treatment plans are provided every six months to support your child’s continued progress. An evaluation of your child’s skills will be conducted after 6 to 18 months of ongoing therapy. This assessment is important for tracking progress and updating treatment goals. Please note that this evaluation will be billed to your insurance as a formal evaluation.These evaluations provide accurate, updated information that allows our therapists to set appropriate goals and deliver the most effective treatment.
CANCELLATIONS (***IMPORTANT):
Consistent attendance is essential for your child’s progress in therapy.
If you are unable to keep a scheduled appointment, please call, email, or leave a voice message by 8:00 AM on the day of the session to avoid being charged.
Missed or late-cancelled sessions may be billed directly to you and are not reimbursable by insurance.
Please note that we cannot guarantee your child’s regular weekly or bi-weekly appointment time will be held if they miss more than two consecutive weeks of therapy. If you anticipate needing an extended break, we kindly ask that you contact us at least one week before your planned return. We will do our best to schedule your child at a convenient time, though availability may be limited, and your child may need to be placed on a waitlist.
We expect a minimum of 85% attendance to ensure consistent progress in therapy.
If your child’s cancellation rate reaches 20% or higher, and you are unable to make up missed sessions during alternative times offered, we may no longer be able to reserve your child’s regular appointment slot. Thank you for helping us support your child’s success in therapy.
CONVERSATIONS OUTSIDE OF THERAPY SESSIONS:
Any communication with your child’s therapist outside of a scheduled therapy session—including phone calls, emails, or text messages—will be billed at a rate of $40.00 per 15 minutes. This fee is not covered by insurance and must be paid at the time of service.
We encourage you to communicate directly with your child’s therapist during scheduled sessions whenever possible to avoid unnecessary charges.
Please remember to review your child's treatment notes in the client portal for updates and information.
SCHOOL MEETINGS:
You may request that a Pediaprogress team member attend a meeting at your child’s school. Attendance is based on staff availability and at our discretion.
If approved, payment is required in advance and will be billed at our current therapy rate. Please contact us in advance to discuss scheduling and availability.
Please contact us at 630.929.0122 with questions regarding Pediaprogress’ policies and procedures.
