The Health Information Portability and Accountability Act (better known as HIPAA) protects information about your child's health and medical record. At Lower Falls Pediatrics your privacy is our priority. You and your child will be able to discuss your child's health with a physician behind closed doors. We try to keep hallways clear in order to facilitate the privacy of conversations.
Due to HIPAA laws, we are unable to fax or mail to any third party; we can only mail them to your home or they can be picked up at either office.
Paperwork with medical information cannot be faxed from our office. Completed forms with health information must be mailed to you (not faxed) or picked up in person. Email must be communicated through a secure server. We are currently using Patient Gateway for such communication.
If you have any questions or concerns about privacy, please contact our main number at 781-772-1527
Privacy for Minors
Trust is an essential aspect of medical care and we at Lower Falls Pediatrics seek trust in all of our health care encounters. Parents and their children are both entitled to this trust. One way that physicians maintain trust is by keeping communications with patients and their families confidential.
Under Mass law, however, adolescents who are 12-17 years of age have special statutory rights that entitle them to confidential communications with their physicians. This means that they can discuss things with physicians they do not wish to tell their parents or other adults, and the physician is required to keep those things confidential. The only exception to this right of confidentiality is when the physician determines that the adolescent is in danger of hurting himself or herself, hurting other people, or being hurt by someone else.
Payment for services is expected at the time of your child's visit. This includes co-pays, deductibles and payment in full when we are not contracted with your insurance carrier. We accept cash, check and credit card (Visa and MasterCard). The accompanying parent or other adult is responsible for full payment and providing current insurance information. You may elect to keep credit card information on file to speed the check-out process.
Copayments for Preventive Visits
A “Well Visit” or “Well Check” does not require a co-payment under the Patient Protection and Affordable Care Act. For your convenience, your physician or provider may discuss or treat your child for a medical condition during your child’s well visit. This saves you from having to make several trips to our office. As a result, a co-payment or deductible may be required by your insurance company if discussions beyond your child’s preventive care occur. Some examples of this are as follows:
- Your Pediatrician needs to change your child’s medication or order tests for a pre-existing/chronic problem
- Your Pediatrician treats your child for any new problems he or she is currently experiencing.
For questions related to your benefits coverage and co-payments, please reach out directly to your insurance company. Our practices collaborate with many health insurance carriers and do not know what benefits you may qualify for under your particular plan.
We bill participating insurance companies as a courtesy to you. You are expected to pay your deductible or co-payment at the time of service. You are expected to pay for all services not paid by your insurance carrier within 10 days of receipt of notification from our office by letter or billing statement. If we have not received payment from your insurance company within 60 days of the date of service, you will be expected to pay the balance in full. You are responsible for all charges.
Accepted insurances include:
- Blue Cross/Blue Shield
Cigna (with exceptions)*
- Local Plus network – we do take, but are not a preferred provider. This means you may have a higher out-of-pocket expense. Always check with your insurance company to see what is covered.
Fallon we take the plans listed below
- Select PPO only
- Fallon Preferred Care (PPO)
- Harvard Pilgrim Health Plan (with exceptions)*
- No BIDMC Select
- No BMC Select
- No Focus Network
Mass Health we only accept
- MGB ACO
- No PCC Plan
- No Standard Masshealth* (we are not accepting new Masshealth members at this time)
Tufts HMO Health Plan we accept most Tufts plans (with exceptions)*
- No Tufts Spirit
- No Tufts Direct
- No Tufts Health Public Plans
- United Health Care
If you have questions or need assistance, please contact our Business Office at 781-772-1527 (Hours: 9:00am-5:00, Monday thru Thursday).
If you are enrolled in a managed care insurance plan you must receive an authorization or referral from our office before seeing a specialist. NO retroactive referral will be given. You should allow 5 to 7 business days for the processing of authorizations/referrals. You will be notified by mail when the authorization has been approved. In general, we will not agree to a referral for a problem we have not been consulted about first.
If you have questions or need assistance with an authorization or referral, please contact our Main number at 781-772-1527.
A records release form must be completed or a signed note from the parent, with your name, complete address, the names of each patient whose records are to be released and the Practice name and complete address to whom the records are to be released. There is a fee for sending records out to a new practice.
Camp and School Forms
A completed generic camp/school form is provided at every well visit for children 4 years and older. This form can be used for all school and camp applications. Please note there is a $10 fee for each additional form we need to print/complete. Please allow up to 48 hours for us to complete all forms from the day they are requested.
No Show Policy
Lower Falls Pediatrics wants you to feel like family. We are committed to giving the best possible service, which includes time with your provider. A no-show is an appointment for which you do not show up. It also includes when you cancel an appointment less than 30 minutes before your scheduled time. We understand last minute problems can’t be helped, but families who no-show more than 3 times may be asked to leave the practice. Not only do your child’s needs go unmet, but a missed appointment prevents another child from being treated. We also do not overbook our schedule to accommodate no-shows. Overbooking means long-wait times and unhappy parents! We don’t overbook so we ask that you don’t no-show. Families who no-show double-well visits for siblings, will not be allowed to schedule double well appointments again. Families who no-show on Saturdays and holidays when we have shortened hours, will also not be allowed to schedule on those days again.
Please plan on arriving 10 minutes BEFORE you scheduled appointment so our staff may check you in and prepare your chart.
If you are unable to keep your regularly scheduled appointment, please call 24 hours prior to cancel or reschedule. Please be advised of the following no show fees for cancellation less than 24 hours prior (we will allow one cancellation within 24 hours prior to charging) or not showing for appointment:
- Well visit ~ $50
- Medication Follow up ~ $50
- Travel Visit ~ $50
- Developmental Visit ~ $200
- Sick Visit ~ $50
We make reminder calls, as a courtesy, beginning 2 days in advance of your scheduled appointment. Regardless of whether you get this call or not, it is your responsibility to come at your scheduled appointment time. Please keep us informed of any changes to your contact information. If you change your cell phone as your primary phone number, please provide us with an alternate phone number or email address so that we may make every effort to remind you of your appointment.
We provide same day sick appointments. To make certain we have a majority of our appointment slots open on any given morning, we ask that you call the day you need the appointment and not earlier. This has helped us reduce our no-show rate since some parents forget about appointments because the child is doing better. We avoid filling up our schedule days in advance so that we can ensure access for everyone when they truly need us.
We do not accept walk-ins except in cases of emergencies. If a parent walks-in for a non-emergency visit and we happen to have an available opening, we will do our best to fit you in. If you must have a specific provider who does not have an opening at that moment, or if there is no opening at all, we will schedule you in the next available spot. If you have to wait for more than 30 minutes for that scheduled spot, we ask that you leave and come back. Walk-ins can increase wait times for everyone, so please be respectful.