503-123-1234
Office: 503-554-0036 | After-hours: 503-294-1732
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Financial Policies

of Kenneth A. Whittaker MD, PC

Our goal is to provide and maintain a positive physician-patient relationship. Letting you know of our office policies in advance allows for a good flow of communication and enables us to achieve our goal. Please read each section carefully and initial. If you have any questions, do not hesitate to ask a member of our staff.

Newborns

  1. It is your responsibility to enroll your newborn on your insurance or apply for Medicaid (Oregon Health Plan, OMAP, YCCO, Care Oregon) no later than 30 days after your child is born.
  2. If your child comes in for a visit prior to coverage being in effect, you will be asked to sign an agreement to pay the amount in full if your child is determined to be ineligible for back dated coverage.

Financial Responsibility

  1. We accept cash, checks, Visa, and MasterCard credit and debit.
  2. A $35.00 fee will be charged for any checks returned for insufficient funds.

Medicaid (OHP, YCCO, Care Oregon)

  1. It is your responsibility to ensure that Dr. Whittaker is assigned as your child’s Primary Care Provider (PCP).
  2. It is your responsibility to maintain your eligibility for Medicaid programs.

Commercial Insurance

  1. It is your responsibility to ensure that Dr. Whittaker is in-network with your insurance plan.
  2. It is your responsibility to keep us updated with your correct insurance information. If the insurance company you designate is incorrect, you will need to provide updated proof of insurance or be responsible for payment of the visit.
  3. If your insurance company requires that you designate a Medical Home or PCP, it is your responsibility to contact the insurance company to make that designation.
  4. Co-payments are due at the time of service.
  5. If, according to your insurance plan, you are responsible for any co-payments, deductibles, and/or coinsurances, it is your responsibility to pay the balance due within 30 days of the date you are billed.
  6. If we do not participate in your insurance plan, payment in full is expected from you at the time of your visit. We will supply you with an invoice that you can submit to your insurance for possible reimbursement.
  7. Patient balances are billed after the first of the month following receipt of your insurance plan’s explanation of benefits. Your payment is due within 30 days of your receipt of your bill.
  8. If you need to make a payment arrangement, contact our office. Any balance outstanding longer than 90 days without an established payment plan will be forwarded to a collection agency.
  9. If you have commercial insurance or are self-pay and your child is here for a Well Child visit or Routine Physical Exam which requires additional time or evaluation, you may be charged an additional co-pay or coinsurance.

Click to Download

Financial Policies Document for Print

Complete List of Clinic Forms

Please call the clinic at 503-554-0036 with any questions regarding these forms.

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