Mohammad Djafari, MD, FAAP



BILLING AND FINANCIAL INFORMATION



PAYMENT POLICY





-Payment for services is expected at the time of your child's visit. This includes co-pays, self-pays and balances from prior visits and payment in full when we are not contracted with your insurance carrier.

-We accept cash, check and credit cards (Visa and MasterCard). The accompanying parent or other adult is responsible for full payment and providing current insurance information.



NON-SUFFICENT FUNDS





All checks returned for non-sufficient funds will be charged an administrative processing fee of $25.00.



REFUND POLICY





Will be applied as a credit to your account, unless otherwise requested.



REQUESTS FOR MEDICAL RECORDS





The first request for a copy of the medical records to the patient will be at no charge. Subsequent requests will be at the current New York State maximum rate of $.75 per page plus postage. Copies of medical records to other than the patient may be subject to a charge at the New York State maximum rate of $.75 per page plus postage.



FINANCIAL POLICY





We are committed to providing the best possible care and are pleased to discuss our professional fees with you. Your clear understanding of our Financial Policy is important to professional relationship. Please let us know if you have any questions. You may contact our billing office.



INSURANCE INFORMATION





If you do not have health insurance, one of our staff members would be happy to assist you. You may also visit your insurance companies website for help.