Financial Policy
Pay My Bill Online:

The following is our financial policy and if you have any questions, you may contact the Billing Office Monday through Friday from 9:00 AM to 5:00 PM.

  1. Responsible Party:
    1. Insurance Billing: AP (Alpine Pediatrics) will submit a claim to the insurance plan that you provide at the time of service. Any charges that are on your account are ultimately your responsibility. It is very important that you make sure we have the correct insurance on file for each child(ren) when presenting for care at any of our offices.
      1. Not all services are payable by insurances. It is your responsibility to know what your insurance plan and benefits cover.
    2. Divorce: A divorce decree is legal document between you, your ex-spouse and the courts. Balances due for minor children are the responsibility of both parents. Both parents will need to coordinate payment to AP.
    3. Unaccompanied minor or other caregiver: You as the parent will be responsible for the charges accrued by your child who comes to an appointment unaccompanied or in the presence of another caregiver (grandparent, neighbor, nanny, etc.)
    4. Patient Center Medical Home: As a Patient Centered Medical Home, we offer complete care for your child(ren) that may also include extensive phone calls to you or a specialist, reporting, consulting and care manager services provided on your child(ren)’s behalf. Your insurance may be billed for these additional services and any unpaid balance will be your responsibility.
    5. No Show: AP makes every attempt to schedule your child’s appointment at the time of day that is best suited for your needs. We do our best to send reminders and notifications of these appointments so that these scheduled appointments are not forgotten. Failure to show for these scheduled appointments may be subject to a no-show fee of $50 for medical care and the cost of the actual visit for any behavioral health therapy visits- (Link to our website policy). No-show fees are not billable to insurance including Medicaid plans and will be your responsibility.
  2. Billable Services:
    1. All services provided by any of our providers or nursing staff may be billed, including supplies used during the visit.
    2. b) Unscheduled sibling visits will require the provider to document the service rendered and will be billed. will require the provider to document the service rendered and will be billed.
    3. All “Follow-Up” visits are still visits with a provider and will be billed.
    4. Separately billed services not included in office visits: This may include but not limited to wart treatments, breathing treatments, spirometry testing, vision screenings in office lab tests, mole or skin lesion removals, splint/cast applications. These extra services are subject to your plan benefits and any remaining balance will be your responsibility
  3. Preventative Services- not all well visits are “free”:
    1. AP follows the preventative care guidelines established by the American Academy of Pediatrics.
    2. A preventative visit is just that, it is a healthy well assessment of your child to address growth, developmental milestones, vision screening, mental health screening and vaccines.
      1. Most insurance plans cover these visits with no out-of-pocket costs for the patient.
        1. Each policy/plan/insurance is different and some do not cover all preventative services.
    3. Occasionally during these visits, the provider may find an illness or other concerns may be brought up by the patient/parent that the provider may address.
    4. If time allows the provider to provide preventative care and address non-preventative care services, you may be billed an additional office visit which is subject to your insurance plan deductible and coinsurance.
    5. If the additional concerns or problems addressed require the provider to choose, they may ask that you bring your child back for the preventative visit.
    6. All of our insurance contracts require our providers to report all services they render at each visit. We are not trying to excessively charge any of our patients, we are required to follow specific guidelines when providing care.
  4. Portion Due at the Time of Service:
    1. If you have insurance, all copayments, deductibles and coinsurance are due at the time of service. If these amounts are not known, a minimum of $50 will be collected.
    2. Payment in full is due at the time of service if you are self-pay. If charges are not ready that day, it is your responsibility to contact us within 48 hours to determine the cost of the visit to qualify for that discount. After that time period has lapsed, you will be billed the full charge.
    3. Payment in full is due at the time of service if you are a foreign exchange student, visiting from out of town or state and do not regularly see a provider at AP. We will bill any United States based insurance plan and reimburse you after they pay.
    4. Auto Insurance. If you do not present with auto insurance including the policy number, claim number, address and phone number of where the claim is to be submitted the balance will be your responsibility. We will send you a claim form that you may submit to the appropriate auto insurance.
  5. Insurance Coverage:
    1. It is your responsibility to provide AP with accurate insurance information at the time of service.
      1. AP will submit charges to the insurance that was provided at the time of service. Not all services are covered by all plans, balances are your responsibility. Questions regarding your benefits will need to be addressed with your insurance plan.
      2. We cannot change the way a claim was billed or change a diagnosis code so that the claim will be paid after the fact. Services are reported accurately and changing a claim after it has been billed is not possible.
      3. We will not be responsible for plans that do not contract with our providers, it is your responsibility to know if your plan covers care provided by any of our providers at AP.
    2. Double Insurance Coverage. It is your responsibility to update your insurance with other coverage that is held by a spouse, ex-spouse, step-parent or other.
      1. Each insurance should coordinate benefits with the other and if they don’t understand that there may be other insurance it may cause the claim to not be paid correctly. The insurance will only update their policy holders plan, they do not take any information from us.
  6. Statements:
    1. Statements are sent after insurance has processed the claim. Each statement will identify the patient, date of service, insurance payment, insurance adjustment and balance due.
    2. Balances in full are due upon receipt of a statement.
    3. If it does not appear correct to you, it is your responsibility to contact the Billing Office as soon as possible.
    4. If we do not hear from you, we will assume the statement was received and correct.
    5. It is your responsibility to make sure we have your correct address and phone number. Any statement that is returned to us in the mail may be sent to an outside collection agency.
  7. Payment Plan Options:
    If for any reason you are unable to pay your balance in full at the time of service or upon receipt of the first statement, please contact our billing office at 801.772.1068 to discuss payment options or ask a receptionist about options. We do not deny access to services due to inability to pay, race, color, sex, national origin, disability, religion, age, sexual orientation or gender identity. A discounted/sliding fee schedule is available based on family size and income. If you decide to apply for hardship, we will require a copy of a legal form of identification, prior year tax return, 2 most recent paystubs, and insurance card. Our financial aid is a sliding schedule based on Federal Poverty Guidelines.

    Sliding Fee Schedule 2023
    Hardship Application

    1. Payment plans may be provided at the discretion of AP.
    2. Payment plans may only be established for up to 3 months. A review may allow an extension after the first 3 successful bi-monthly or monthly payments have been received.
    3. Payment plan payments are due on the agreed upon date. If payments are missed your account may be turned over immediately to an outside collection agency without further notice.
    4. Payment plans are for past due balances and do not include new balances.
      1. New balances are to be paid separately and will not be added to an existing payment plan.
      2. You will receive a statement indicating when new balances are added, it is your responsibility to contact AP to pay those new balances.
    5. Failure to follow any or all of the payment plan requirements will render the agreement null and void and unpaid balances may be referred to an outside collection agency.
  8. NHSC:
    1. AP participates with NHSC to assist patients with unpaid medical expenses.
    2. In order for us to determine if you qualify for any additional adjustments, you must complete an application for this assistance. Click here for the forms and instructions.
  9. Collections:
    1. Unpaid balances are referred to an outside collection agency under the following circumstances:
      1. Invalid address or phone number.
      2. Failure to provide accurate insurance information.
      3. Failure to pay patient balances.
      4. Failure to satisfy payment plan agreements.
      5. Failure to respond to AP collection efforts.
    2. AP makes every effort to keep your account out of collections. If your account is referred to an outside third-party collection agency you will be responsible for the balance plus an additional fee up to 40% of the amount owing as allowed by Utah Code Annotated, sec. 12-1-11. You may also be charged reasonable attorney fees incurred by AP in connection with enforcement or collection of this agreement.
  10. Bankruptcy:
    1. If AP receives notice from the courts of a Bankruptcy case on your account, we will make necessary adjustments according to the bankruptcy law.
    2. Future visits will require insurance verification prior to service and patient portions will need to be paid.
  11. Dismissal from Practice:
    1. You may be dismissed from our practice if you fail to pay patient balances.
    2. If we receive a bankruptcy notice and have to adjust off $350.00 or more according to the bankruptcy.
    3. A letter notifying you of this action will be mailed to you prior to dismissal and your account with all children will be flagged as “pending dismissal.”
    4. We will provide urgent or emergent care for 30 days from the date of the letter to allow you time to find a new provider.
We encourage you to ask your insurance plan important questions regarding your benefits such as:

Do I have well child or preventative care for my child?
Is there a limit or maximum benefit to the well child or preventative care?
Are the vaccines covered by my insurance?
Are there vaccine coverage limitations? Alpine Pediatrics follows the current immunization guidelines established by the American Academy of Pediatrics (AAP) and the Center for Disease Control’s Advisory committee on Immunization Practices (ACIP).
If my child is having an office procedure done, such as wart removal, mole removal, fracture care, laceration repair etc.; what will I be responsible to pay?
Does my plan have a deductible that will need to be paid each year and how much is my deductible?
How much is my copayment?
Coinsurance is a percentage of the charges that may be your responsibility and is not part of the copayment.
Is the physician or physician assistant participating with your insurance plan?