Haywood Pediatrics' Sliding Fee Discount Program
Haywood Pediatrics offers a Sliding Fee Discount Program in order to help those in need who do not have insurance coverage to obtain medically necessary care.
No child will be denied medically necessary care, regardless of the family's inability to pay.
To see if your family qualifies, we will need the following from you:
1. A completed application.
2. Proof of income for household- i.e. checkstubs, tax returns, unemployment or pension benefits, interest payments, child support, Social Security and other public assistance benefits, etc.
3. Proof of Identification & Address- i.e.- Drivers license, Utility bill, etc.
The application must be renewed annually. If the family fails to pay, they are subject to normal office procedures for collection of debt.
For questions or more information about this program, please call 828-452-2211 ext. 1117
SCHOOL NOTE POLICY
School notes will ONLY be issued for the date the child is seen. The parent/guardian may send a note for any additional days they are absent. Our purpose in providing a school note is to state that your child has been seen at our office. It is not meant to document length of illness or when a child can return to school. HIPAA privacy laws restrict disclosure of specific diagnosis information without written permission from the parent/guardian. School notes will be faxed to the schools; we can also supply a printed copy to the parent/guardian as a work note, if needed.
CONSENT FOR TREATMENT
For a child to be seen in either office whoever brings them to the office MUST be listed on the demographic sheet, have written permission, or have a consent for treatment document. We can no longer accept verbal consent.
18 YEARS AND OVER POLICY FOR CONSENT:
After someone reaches age 18 they are responsible for their own consent. The parent can no longer consent to treatment or obtain information, or ask that it be released to anyone else. In simple terms, the 18+ year old has to sign all legal documents. We must have written permission from the 18+ year to speak with their parents to share information with them such as for interview purposes, or to offer results.
Parents may schedule their child's routine appointments with the provider of their choice. They may also request a specific provider for sick visits. The provider given is dependent on schedule availability and parental convenience. We do our very best to accommodate each family.
New Parents: If you are about to become a new parent, we encourage you to make an appointment to meet us. There is no charge for this prenatal visit.
New Patients: Please come 15 minutes early to fill out necessary information forms.
- Please bring your child’s immunization record.
- Please bring all your child's medications or a complete list of your child's medications to EVERY appointment. This includes; prescription medicines, over-the-counter medicines, herbal medicines and vitamins and supplements.
- Sick or injured children will be worked into the schedule as soon as possible.
- If your child is seriously ill or injured, please alert our staff immediately.
- Please communicate with our staff if you feel your child’s visit will require more than the usual amount of time. Examples of this include serious behavioral problems, premature infants, gynecological exams, or any child who has a chronic illness or disease.
- Please call us to cancel appointments you do not wish to keep.
- When one of your children has an appointment, please do not bring other children to be seen unless you have notified us first. Each child will have a separate visit and an additional appointment time is required. There will be a charge for each child seen.
- School, camp, and sports physicals need to be scheduled well in advance. This is especially important at the beginning of a new school year. Please bring all your forms with you and fill out as much as you can at home.
- If you are more than 15 minutes late for your appointment please check with the assistant at the check-in desk to see if the practitioner can still see you. We can rarely see patients who are more than 15 minutes late for an appointment.
- If you have waited more than twenty minutes after signing in, please notify one of our staff.
- NO-SHOW POLICY: Please, if you cannot keep an appointment, call and cancel. We prefer that you call 24 hours in advance to cancel. It is the policy of the office that you may be dismissed from the practice if you have more than two no-shows in a one year period.
- Click HERE for our vaccine policy.
Thank you for considering to choose our practice, We are committed to assisting you with your insurance and financial obligations. We accept insurance assignment, cash, checks, Visa and MasterCard.
Please read our financial policy below:
Haywood Pediatrics is committed to caring for the children and youth of Haywood County and providing excellent care to sick children regardless of their financial situation. To assist you, we have the following policy. If you have any questions, please speak with a member of the staff.
Unless other arrangements have been made in advance by either you or your health coverage carrier, full payment is due at the time of service. We accept Cash and Credit/Debit Cards.
We expect timely payment for our services but are willing to discuss payment plans for the parents of sick children who are experiencing economic hardship.
Following are our financial policies:
Payment is expected at the time services are rendered.
- The adult (parent/legal guardian) who signs the demographics will be considered the guarantor and will be responsible for all balances not covered by insurance, including vaccinations, even if that adult is not present at the time of service. We do NOT honor custody agreements nor court orders.
- All insurance co-pays are to be paid upon check-in.
- We expect regular payments (at least every 30 days) on outstanding balances and the patient representative is responsible for setting up payment arrangements with Haywood Pediatrics. Failure to do so may result in your account being referred to a collection agency and your family may be terminated from the practice.
- Routine Care and Wellness visits will not be scheduled until outstanding balances are settled or adequate payment arrangements have been made.
(Please present patient’s insurance card at each visit)
As a courtesy, we will file claims for all visits. However, payment is expected at the time of service for co-pays, deductible amounts, etc. and it is the responsibility of the patient representative to verify with the insurance that we are participating with their policy and to know what benefits are covered. If you are uninsured, we can give you information about getting coverage through NC Medicaid or on our Sliding Fee Schedule Program.
We are contracted with the following Insurance companies:
- Crescent/Kanawha Health Care Solutions
- Health Care Savings
- Blue Cross/Blue Shield of NC
- United Healthcare
Site User Policy:
In case of an emergency, do not post a message. Instead, please call 911
We encourage you to leave comments; however, we will review comments and will remove any that are inappropriate or offensive at our discretion.
The comments posted on this site ("User Content") do not necessarily reflect the opinions or ideals of Haywood Pediatric & Adolescent Medicine Group, PA ( hereafter referred to as Haywood Pediatrics), its employees or affiliates.
For purposes of these Rules, the term “User Content” also includes any photos, videos, music or any other materials or content.
Messages posted to our sites and the content therein are not encrypted or secured by other means, and are available for unlimited viewing and printing. You are solely responsible for the content of your postings.
Haywood Pediatrics and the employees, affiliates and agents thereof are not responsible for any claims, damages, losses, liabilities, costs or expenses that directly or indirectly result from your use of your posted message content.
Haywood Pediatrics disclaims responsibility for defamation, obscenity or any Message Board content that may be considered inappropriate
- User Content is your own original work - does not infringe the copyright or any other rights of any third party;
- Third-party links may be deleted, and self-serving posts will be blocked;
- When posting messages, keep discussion as close as possible to the topic at hand;
- Avoid posting copyrighted or trademarked material. If such material is posted within your message, you are solely responsible for such content;
- Use of expletives, obscenities, or potentially libelous, defamatory, threatening or inappropriate words or statements;
- Does not contain any illegal content or material; and
- You have the permission of all persons shown in the User Content to post their image
- Publishing of another person’s personal information without permission is prohibited and you are solely responsible for such content;
You grant Haywood Pediatrics a royal-free and fully-paid license to use and display the User Content throughout the world in any type of electronic or digital media for marketing and/or public relations purposes in perpetuity.
You consent to allow Haywood Pediatrics to contact you through email (or as otherwise indicated by you) regarding any request Haywood Pediatrics may have related to obtaining permission from you to use the User Content.
You agree to bring complaints and concerns to the attention of Haywood Pediatrics before discussing them in the community or online.
OCR NOTICE Of Nondiscrimination
Source: HHS Office for Civil Rights
Haywood Pediatric and Adolescent Medicine Group, PA
complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, religion or sexual orientation.
Haywood Pediatric and Adolescent Medicine Group, PA
does not exclude people or treat them differently because of race, color, national origin, age, disability, sex, religion or sexual orientation.
Haywood Pediatric and Adolescent Medicine Group, PA
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats)
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact Name of Civil Rights Coordinator.
If you believe that Haywood Pediatric and Adolescent Medicine Group, PA, has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, sex, religion or sexual orientation, you can file a grievance with:
You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Chris Henson, Business Manager is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/loggy.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue SW
Room 509F, HHH Building
Washington, DC 20201
Toll Free: 1-800-868-1019
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Haywood Pediatric and Adolescent Medicine Group, PA, complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, religion or sexual orientation..
Language Assistance Available:
Español (Spanish): si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-828-452-2211.
繁體中文 (Chinese): 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-828-452-2211.
Tiếng Việt (Vietnamese): CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-828-452-2211.
한국어 (Korean): 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-828-452-2211.
Français (French): Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-828-452-2211.
العربية (Arabic):ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-828-452-2211 (رقم
Hmoob (Hmong): Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-828-452-2211.
Русский (Russian): ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-828-452-2211.
Tagalog (Tagalog – Filipino): PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-828-452-2211.
ગુજરાતી (Gujarati): સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓતમારા માટે ઉપલબ્ધ છે. ફોન કરો 1-828-452-2211.
ខ្មែរ (Cambodian): ប្រយ័ត្ន៖ បើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, សេវាជំនួយផ្នែកភាសា ដោយមិនគិតឈ្នួល គឺអាចមានសំរាប់បំរើអ្នក។ ចូរ ទូរស័ព្ទ 1-828-452-2211.
Deutsch (German): ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-828-452-2211.
हिंदी (Hindi): ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-828-452-2211.
ພາສາລາວ (Lao): ໂປດ ຊາບ: ຖ້າ ວ່າ ທ່ານ ເວົ້າ ພາ ສາ ລາວ, ການ ບໍ ລິ ການ ຊ່ວຍ ເຫຼືອ ດ້ານ ພາ ສາ, ໂດຍບໍ່ ເສັຽ ຄ່າ, ແມ່ນມີ ພ້ອມໃຫ້ ທ່ານ. ໂທ ຣ 1-828-452-2211.
日本語 (Japanese): 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1-828-452-2211.