• Our office expects payment at the time of service unless specific arrangements have been made in advance with our billing department. This includes co-pays, deductibles and non-covered services.

  •  IT IS YOUR RESPONSIBILITY TO INFORM US OF ANY CHANGES WITH YOUR INSURANCE.  Many insurance plans have “timely filing deadlines”. If we are not provided with accurate information at the time of service, you may be responsible for payment in full for all services rendered.

  •  Please keep in mind that your insurance is a contract between you and the insurance company.

  •  Not all insurances cover all procedures.

  • While we make a good faith attempt to verify coverage, we are not able to guarantee that the information given to us by you or your insurance is correct.

  • It is your responsibility to know your child’s insurance benefits and preventive (“well”) services schedule limitations. Specifically, the number of visits allowed at each age and whether the schedule is based on a calendar year or every 365 days.

  • Well checks/and services scheduled too early or in excess of patient benefits will be your responsibility.

  •  If your child is diagnosed with an illness while being examined for a well check, there will be two visits billed. One visit for the illness and the other for the well check. You understand that in this rare instance, a copay or deductible will apply and will be collected for the sick visit.

  • You understand that payments collected at the time of the appointment are only ESTIMATES and that there is a possibility that you will receive a bill for additional charges or a credit to your account.

  • You agree to keep a credit card, debit card, or HSA card on file with our office OR place a deposit on your account for an estimated patient responsibility payment of services at each appointment.

  • Lastly, you understand that if the payment card is declined for any reason an additional fee of $35.00 will be applied to your account (same as a bad check fee).
Patients without Insurance/Self-Pay Patients have the right to receive a “Good Faith Estimate” explaining how much your medical expenses will cost. Please call our office to request an estimate prior to your appointment.

We require a credit card to be on file and current for all appointments. Your credit card information is not kept on file in this office. It is kept securely offsite by our Payment Gateway known as Health iPASS and our office does not have access to the full credit card number.

We respectfully ask that you refrain from asking your doctor to examine siblings that do not have appointments. This prevents us from properly documenting the visit in the medical record, as well as prevents us from seeing the next scheduled patients on time. If you know prior to your scheduled appointment, we will do everything we can to try and work you in with your provider or another available provider.

Pediatric Associates of Austin providers and staff are dedicated to our patients and to providing quality medical care to your child(ren.) Our focus is on your child’s medical, emotional, psychological and physiological health. We are not party to your divorce decree or to be involved in any legal issues involving divorce, separation or custody.

The responsibility for payment and the presentation of active insurance cards at the time of service is the responsibility of the accompanying adult.

If you need medical assistance after 5:00 pm or on the weekend, we not only offer our nurse triage line, but we also provide morning appointments on Saturday and Sunday, as well as our After Hours Kids Clinic 7 nights a week beginning at 6:00pm. There is a nominal fee of $25.00 for after-hours calls to our dedicated nurse triage line. If seen at our After Hours Kids Clinic, a $30 fee will be charged.
Our office values its patient relationship and wants to protect patients’ rights. We will terminate the patient relationship with cause and after careful consideration. Reasons for termination include: repeatedly not showing up for scheduled appointments, not complying with recommended medical care, not complying with our vaccine policy, being hostile or abusive to staff, not paying bills or requesting a payment plan in a timely manner.


Purpose of this Notice

Pediatric Associates of Austin, P.A. (PAA) is required by law to maintain the privacy of your protected health information (PHI). This notice applies to all records of the health care and services you received at PAA. This notice will tell you about the ways in which we

may use and disclose your PHI. This notice also describes your rights and certain obligations we have regarding the use and disclosure of your PHI. A more detailed version of this notice may be found on PAA’s website and a paper copy will be provided upon request.

Pediatric Associates Commitment

We are required by law to: (i) make sure that your PHI is kept private; (ii) give you this notice of our legal duties and privacy practices with respect to your PHI; (iii) follow the terms of this notice as long as it is currently in effect (if we revise this notice, we will follow the terms of the revised notice as long as it is currently in effect); (iv) train our personnel concerning privacy and

confidentiality; and (v) mitigate (lessen the harm of) any branch of privacy/confidentiality.

How We May Use and Disclose Information about You

The following categories (listed in bold-face print, below) describe different ways that we use and disclose your protected health information (PHI). For each category of uses or disclosures we will explain what we mean and give you some examples, but not every use or disclosure in a category will be listed.

For Treatment. 

We are permitted to use and disclose your PHI to doctors, nurses, technicians, medical students or other personnel who are involved in taking care of you or providing you with medical treatment or services. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. We also may disclose your PHI to health care providers that are not affiliated with Pediatric Associates who may be involved in your medical care, such as physicians, who will provide follow-up care, physical therapy organizations, medical equipment suppliers, and skilled nursing facilities.

For Payment. We are permitted to use and disclose your PHI so that the treatment and services you receive at/by PAA may be billed to (and payment may be collected from) your insurance company or a third party. For example, we may need to give your health plan information about the procedure you received at PAA so your health plan will pay us or reimburse you for the procedure.

For Health Care Operations. We are permitted to use and disclose your PHI for our business operations. These uses and disclosures are necessary to run PAA and to make sure that all of our patients receive quality care. For example, we may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you.

To Business Associates for Treatment, Payment, and Health Care Operations. We are permitted to disclose your PHI to our business associates in order to carry out treatment, payment of health care operations. For example, we may disclose your PHI to a company we hire to bill insurance companies on our behalf to help us obtain payment for health care services we provide.

Individuals Involved in Your Care or Payment for Your Care. We may release your PHI to a family member, other relative, or close personal friend who is involved in your medical care if the PHI released is directly relevant to the person’s involvement in your care. WE also may release information to someone who helps pay for your care. We may tell your family or friends that you are at PAA and what your general condition is.

Other Uses/Disclosures. We may use and disclose medical information: (i) to tell you about health-related benefits or services that may be of interest to you; (ii) to give you information about treatment options or alternatives that may be of interest to you; or (iii) to contact you as a reminder that you have an appointment for treatment or medical care at PAA.

Special Situations: We will disclose your PHI when required to do so by federal, state, or local law.

Public Health Activities: We may disclose your PHI for certain public health activities (e.g., controlling disease, injury, or disability; reporting abuse or neglect; reporting drug reactions), but only if you agree or when required or authorized by law.

Health Oversight Activities. WE may disclose PHI to a government health oversight agency for activities authorized by law such as audits, investigations, inspections, and licensure.

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court of administrative order or in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute.

Law Enforcement. In certain designated situations, we may release PHI if asked to do so by a law enforcement official.

Coroners, Medical Examiners, and Funeral Directors. We may release PHI: (i) to a coroner or medical examiner to identify a deceased person or to determine the cause of death; or (ii) to a funeral director as necessary to help them carry out their duties.


Other Special Situations. We may use and/or disclose PHI: (i) to organizations that handle or facilitate organ procurement or transplantation; (ii) to law enforcement when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person; (iii) as required by applicable military command authorities (if you are a member of the armed forces); (iv) to authorize federal officials for certain national security purposes; or (v) for workers compensation purposes.

When Your Authorization is Required

Uses or disclosures of your PHI for other purposes or activities not listed above will be made only with you written authorization (permission). If you provide us authorization to use or disclose your PHI, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written permission.

However, we are unable to take back any disclosures we have already made with your permission.

Your Rights: You have the following rights regarding the PHI we maintain about you:

Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for you care. We are not required to agree with your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by telephone at work or that we only contact you by mail at home. We will accommodate all reasonable requests.

Right to Inspect and Receive a Copy. You have the right to inspect and receive a copy of PHI that may be used to make decisions about your care. Psychotherapy notes may not be inspected or copied. We may deny your request to inspect or receive a copy in certain very limited circumstances.

Right to Amend. If you believe that PHI we have about you is incorrect or incomplete, you may ask us to amend the information.

You have the right to request an amendment for as long as the information is kept by or for PAA. You must include a reason that supports your request. We may deny your request for an amendment in certain limited circumstances.

Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures” that has been made by PAA in the past six (6) years.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice (even if you have agreed to receive this notice electronically). You may ask us to give you a copy of this notice at any time.

Changes to this Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on PAA premises and on PAA’s website. The notice will contain, in the lower left-hand corner, the effective date. In addition, each time you register at, or are admitted to, PAA for treatment purposes, you may request a copy of the current notice in effect.

Requests, Questions, and Complaints

If you have any questions or would like additional information on these rights, you may contact the PAA Privacy Officer at 512-458- 5323. Additionally, if you believe your privacy rights have been violated, you may file a complaint with either PAA’s Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201. You will not be penalized in any way for filing a complaint.

Controlled substances, including narcotic pain medications and stimulants used to treat ADD/ADHD and other mental health issues, are medicines whose power we take very seriously and are closely

monitored for overuse. The American Academy of Pediatrics guidelines and standards of good care dictate that we appropriately monitor their use, beneficial effects and potential side effects. Children who take these medicines should be seen at a minimum of every six months without exception.

Between annual physical exams and consultation visits, a visit with one of our nurse practitioners will be needed routinely during the first year of diagnosis or when medication changes are needed. At these visits, medication side effects will be monitored, school performance and family dynamics will be reviewed, and prescriptions will be

refilled. We are particularly interested in blood pressure monitoring and growth assessment.

Consultation visits should be scheduled any time a problem develops related to the ADHD or the medication.

Prescription Refills:

  1. Appropriate refill requests can be made via phone or email. When calling our office, choose the option for “prescription refills”.
  2. Provide our staff with the patient’s name, date of birth, medication name, dosage needed, and the pharmacy

name and location you would like it sent to.

  1. Please allow our staff three business days from the date of request to fulfill the prescription refill.
  2. We ask families to please time their refill requests accordingly.

When we receive a refill request for a patient’s fifth month on a controlled substance, we will:

  1. Contact the family to set up their next med check or yearly physical exam.
  2. If the patient does not have a med check or yearly physical set up when we receive a request for the sixth month, we will again contact the family to set up an appointment.

Pediatric Associates of Austin has updated our vaccination policy in accordance with the recommendations of the American Academy of Pediatrics and the Centers for Disease Control.

Our first and most important priority is the safety and well-being of our patients. Vaccines are one of the safest and most effective ways to protect your child against diseases that can cause serious illness or even death. Vaccinating all children is an important way to minimize exposure to vaccine-preventable illnesses for our most vulnerable patients, including newborns, children with weakened immune systems and pregnant women.

Current families whose children are missing vaccinations will also be required to discuss with their physician a plan to complete required vaccines. As always, we will continue to care for patients who cannot receive vaccines for medical reasons.

Thank you for your understanding. Your child’s health is of utmost importance to us.

Please contact our office if you have any questions or concerns.