Financial Policy

FINANCIAL POLICY AND PAYMENT AGREEMENT

Insurance, self-pay, payment methods, outside-provider charges, payment plans, and collection practices.

This policy explains insurance, self-pay, payment, outside-provider charges, cards on file, payment plans, and collection practices. “Kinder” means KPUC LLC d/b/a Kinder Pediatric Urgent Care.

1. Insurance and network status

• Kinder participates with many New Jersey health plans, including certain Medicaid and NJ FamilyCare managed-care plans. Participation may differ by plan, product, location, or clinician and may change. Confirm coverage with your plan.
• Provide current insurance information and respond promptly to health-plan requests. Kinder submits claims and reasonably assists with processing.
• Patients are responsible for permitted deductibles, coinsurance, copayments, and noncovered charges. Kinder does not balance bill when prohibited by law or contract, including applicable New Jersey protections for inadvertent out-of-network and urgent or emergency services.

2. Medicaid and NJ FamilyCare

For covered Medicaid or NJ FamilyCare services, Kinder accepts the plan’s payment as payment in full and collects only cost sharing specifically permitted by the plan. If Kinder knows in advance that a requested service is not covered, we explain the expected charge and obtain any acknowledgment required by the program.

3. Self-pay and Good Faith Estimates

If uninsured or not using insurance, payment is due at the time of service unless another arrangement is approved. Current prices are maintained in Kinder’s written self-pay fee schedule.

4. Responsibility for payment

An adult patient is responsible for amounts properly owed for the adult patient’s care. For a minor patient, the parent or legal guardian who signs the agreement accepts personal responsibility, as guarantor, for amounts properly owed and not paid by insurance.

An adult who is not the patient’s parent or legal guardian does not become responsible merely by presenting the patient for care and becomes a guarantor only by affirmatively accepting that role in the signed agreement. Kinder does not determine how parents divide medical expenses between themselves.

5. Outside laboratories and suppliers

Independent laboratories and independent DME or nebulizer suppliers are separate organizations and may bill under their own prices, network participation, and financial policies. Kinder does not bill for third-party DME or nebulizer products.

6. Assignment of benefits

Patients may assign insurance benefits payable for KPUC services and direct the health plan to pay Kinder. HIPAA generally permits Kinder and its billing business associate to use and disclose information for payment without a separate authorization.

7. Payment methods and card on file

• Kinder accepts major credit cards, debit cards, HSA/FSA cards, and cash.
• For patients who are not covered by Medicaid or NJ FamilyCare, Kinder ordinarily requests a card on file where permitted by law and payer contract, unless Kinder approves another arrangement. Kinder does not request or keep a card on file for patients covered by Medicaid or NJ FamilyCare.
• Card information is maintained by a third-party processor; Kinder does not retain the full card number in the medical record.
• Any authorization to keep or charge a card is optional and is not required for care. If authorization is provided, a later card charge occurs only as described in the signed Financial Policy, including after required notices and an offered reasonable payment plan.
• Kinder does not make such a charge during an insurance review or appeal or while the patient complies with a payment plan. Authorization for future card charges may be revoked without eliminating a valid debt.

8. Statements, disputes, and payment plans

Statements are due within 30 days. During a pending internal or external insurance review or appeal, Kinder will not make collection communications, refer the amount, or file a collection lawsuit. Before collection action, Kinder offers a written reasonable payment plan consistent with New Jersey law, including affordability standards, an ordinarily six-month-to-five-year term, adjustment for financial changes, a 60-day grace period, and no more than the lawful interest limit.

9. Collections

Kinder may refer unpaid medical debt only after all legal conditions are met, including at least 120 days after the first bill, at least 90 days after Kinder’s last written collection notice, an offered reasonable payment plan, and the additional bill and notice required at least 30 days before collection action. Kinder does not take action against a patient complying with a plan or while an insurance review or appeal is pending. Kinder does not report medical debt when New Jersey law prohibits reporting.

10. Returned payments, appointments, and services

• A $25 fee may be charged for a returned check to the extent permitted by law. Kinder does not charge this fee merely because a credit-card transaction is declined.
• Kinder does not charge an appointment cancellation or no-show fee.
• Sports physicals are $25.

11. Medical records

Records are available as described in the Notice of Privacy Practices. Lawful copying charges may apply. Records needed for ongoing care are not withheld because of an unpaid treatment balance.

12. Financial assistance

Contact Kinder before a balance becomes past due if payment would cause hardship. Kinder may offer a payment arrangement and information about NJ FamilyCare. Any waiver or reduction must be permitted by law and payer contract.