Patient Financial Policy

Columbus Pediatrics is committed to providing you with the best possible care and glad to discuss our financial policy with you at any time. Your clear understanding of our Financial Policy is important to our professional relationship. The responsible party is the designated person to see that the entire bill is paid in full. Please feel free to contact us at (812) 376-9219 for any assistance you may need.

Prepare for your visit

  • Always bring your current health insurance card(s) at every visit.
  • Always bring your Photo ID with you.
  • Notify us of any changes to insurance, address, telephone or family status.
  • Co-pays, deductibles and co-insurance are due at time of service.
  • Bring form of payment. We accept cash/check/credit/debit cards.
  • Bring information required to fill out forms. (see Required information section below)

Required Information

  • Patient name, address, phone number, gender, date of birth, social security number, insurance ID and group number.
  • Subscriber name, address, phone number, gender, date of birth, social security number, relationship to patient
  • Provide the Responsible Party's name, address, phone number, gender, date of birth, social security number, and relationship to patient.
  • If any of this information is not provided, payment in full is required at time of service.

Time of Service Payments

  • Co-pays, Co-insurance and deductibles.
  • Self-insured patient payments.
  • Any balances past 30 days.
  • Payment for services rendered to patients whose insurance is out of network.

Payment Options

We accept Cash, Check, Debit, Master Card, Visa, American Express and Discover.

Payment Plans

We realize you may have financial problems, at times, making immediate payment difficult. Please feel free to discuss this with us. While we are concerned about our collections and expense, your child's medical care is our priority. We always try to honor a faithful relationship.

To make any financial arrangements at anytime call: (812) 376-9219 ext 3506.


The fee schedule has been designed to represent the usual and customary charges. It reflects time spent, supplies needed and the complexity of the problems and/or procedure. This may not always agree with your insurance company's global, usual and customary determinations.


We currently have contracts with Anthem, Indiana Medicaid (MHS, MdWise Care Select), SIHO, Encore, Sagamore, PHCS, Aetna, Cigna, United Healthcare, Humana, Champus and Super Med. We will not accept discount from non-contracted payors.

A current card must be presented at every visit in order for us to file your claim. Co-pays, deductibles and co-insurance (the percent you owe at every visit) are due at time of service.

You may also present your insurance card for a non-contracted insurance that you wish us to file on your behalf. Payment responsibility remains yours. If your insurance does not satisfy the claim within 30 days, the balance is then due from you.

Understanding your Insurance Benefits

  • You are responsible to understand your benefits and keep us informed.
  • You should know if you do or don't have Preventative Benefits, what it includes and doesn't include and how much. This is your responsibility.
  • Know the amount of your deductible and when your services are due in full.
  • Know if you need a referral to a specialist or for testing.
  • If the patient receives additional information required by the insurance company thirty days are allowed for providing said requested information to the insurance company before we turn the entire balance over to patient responsibility.

Understanding the Insurance Claim Process

  • Our office will send the claim to your insurance company.
  • Your insurance company processes the claim and sends the patient and the provider an Explanation of Benefits (EOB). This shows you how your claim was processed.
  • Our office will then send a statement to the patient for remainder of balance. This balance is due within (10) days.

Your insurance REQUIRES that we collect your designated co-pay at the time of service. Please be prepared to pay the co-pay at each visit.

If you have not met your deductible -- we will estimate the expected insurance payment for your visit and request that amount at check-out-this is an estimate only -- you may receive a statement with additional balances.


If you have a balance on your account, we will send you a statement. The balance on your statement is due and payable when the statement is issued, and is past due if not paid within ten (10) days.

Guarantor/Responsible Party

(person who child resides with must be responsible for the bill)

The person with whom the child/children resides will be listed as the guarantor. If someone other than the guarantor carries insurance, the insurance information will reflect this. We expect payment from the person who brings the child in for services, and we do not get involved with billing other persons or waiting for the conclusion of court cases. Our system currently does not accommodate a two party billing.


In case of divorce or separation, the parent authorizing treatment for child/children will be the parent responsible for those subsequent charges. If the divorce decree requires the other parent to pay all or part of the treatment costs, it is the authorizing parent's responsibility to collect from the other parent.

Overdue Balances

We urge patients to keep their accounts current and in good standing with our office. If a payment cannot be made on time, it is crucial that parents/patients call to set up a payment plan at: (812) 376-9219 ext 3506.

All account balances past due will be referred to a collection agency after 120 days. Any charges and fees resulting from this action, including collection agency fees, will be added to your account balances and will be your responsibility. We are not responsible if this affects your credit.

Returned Checks

There is an $18.00 charge for returned checks. If two checks are returned, you will no longer be able to write a check to our office.

Medical Record Copies

Indiana Law IC 16-39-9-4 directs the fees allowed for copying your medical records.

  • $1.00 per page for first 1-10
  • $ .50 per page for pages 11-50
  • $ .25 per page for pages 51 and higher
  • Add $10 if the requested within (2) working days
  • Add $20 for certification