FAQ & Forms

Deductibles & Copays

All insurance deductibles and copays are due at the time of service. We do not bill for copays. If you are a new patient, these amounts may be collected prior to your visit. If you are established with our practice, these copays may be collected as you depart after your visit. If your insurance eligibility cannot be confirmed prior to your visit, you will be responsible for the total visit amount on the date of service. Patients who have state funded insurance, i.e. Medicaid or Wellcare whose insurance cannot be confirmed will also be financially responsible for services rendered.

Unpaid accounts with no activity for ninety (90) days may be turned over to our collection agency which will result in a dismissal from our practice.

Our office maintains a twenty-four (24) hour prescription refill policy. Refills on medications will be called into your pharmacy or ready for pick-up the day following your refill request.
We will work with patients to reschedule appointments; however, three (3) appointments that are missed or broken will result in dismissal from our practice. You will be notified by mail of your child’s dismissal from our practice. We will continue to provide emergency medical care for up to 30 days following the dismissal. We work hard to make sure that our patients are seen on time and we want to make sure that patients who need appointments are seen as quickly as possible.
Requests for shot records and the completion of health forms (school physicals, insurance requests, medication for school administration) will be completed within 24 to 48 hours. A fee of five dollars ($5.00) will be charged if these forms are not completed in conjunction with an office visit. Complete copies of medical records will incur a fee of twenty dollars ($20.00).

At Lifeguard Pediatrics we understand that issues related to divorce are very difficult for the entire family. However, we will not be party to custodial, separation or financial disputes relating to individuals with regard to minor children to whom services are provided. All copays, co-insurance and deductibles will be collected at the time of service from the individual accompanying the child at the visit. Both parents have access to the minor child’s medical records unless we are provided a copy of a court order that mandates otherwise.

“We maintain that divorce, separation and custody agreements should not take precedence over the provision of medical care for a child; such matters should remain between the parents.”



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