Our Pediatricians and staff would like to extend to you a warm welcome to our pediatric and adolescent medicine practice. We are here to provide your child(ren) with excellent medical care, a safe and reassuring environment and a friendly setting. Please take a moment to read our office policies.
Medical Records
All new patients must have medical records faxed/mailed to us prior to scheduling any physical examinations or receiving any vaccines. We vaccinate all our patients, if you are not in compliance please seek a doctor that will accommodate your decision not to vaccinate your child(ren). We follow the American Academy of Pediatrics immunization schedule. If you are transferring from another doctor’s office, please provide us with a copy of the immunizations, this will enable us to give your child the immunizations he/she may need in a timely manner.
Sick Visits
Appointments are available for same day sick visits. We do not take Walk ins. Please call the office ahead and make an appointment. If your child is sick, we will definitely accommodate you. Call early as these do fill up quickly. This may results in a wait to be seen by the doctor, we ask for your patience. Everyone will get the time that they need. Please arrive 15 minutes prior to your appointment to complete/update insurance information and personal demographics, it is most important to keep us informed of any changes in your personal information. Additionally all insurance cards must be presented at the time of the appointments. Any patient under the age of 18 must be accompanied by a parent/legal guardian to appointments.
Well Care Examinations
All Well Care Visits should be scheduled 2-4 weeks in advance. Schedule can be downloaded from the Forms page.
Family Information
It is each parent’s responsibility to maintain their family file/information up to date. In case of an emergency, it is important to have your most updated phone numbers, address and email address. Email addresses are convenient to confirm your child’s upcoming appointment and other administrative communications. By providing our office your email address, you give us permission to communicate with you by these means. Please do not email us urgent requests.
After Hours and Weekends
If you have a medical emergency after office hours or on the weekend and feel you need to reach Dr. Qasba please call (301) 776-2700. On this number will be a recording with instructions on how to reach Dr. Qasba. Please do not call any other phone number first. Referral appointments or prescription refills are not emergencies and will only be addressed during normal business hours.
Insurance Coverage
It is your responsibility to keep our office informed of any insurance changes for your family. The contract between the insurance companies is between you and them. Please respond in a timely manner when our office, the insurance company, the state of Maryland or your county DDS sends you correspondence regarding your coverage. If these letters are not addressed, you will be responsible for any charges incurred for services. If you have two insurances it is your responsibility to inform us of both insurances. In case you fail to do so and the doctor does not get paid, you will be liable for this bill.
Cancellations/Missed Appointment Policy
Your appointment time has been reserved exclusively for you. Therefore, we require 24-hour notice for cancellations. There is a $25 fee for all missed appointments. If you are more than 15 minutes late you may be asked to wait or reschedule your appointment. Please call ahead of time if you will be late.
Health Forms
We are happy to complete forms for school, camp, etc. The charge is $5.00. If your child has not had a physical exam within the last 12 months we cannot fill the forms until he/she has a current physical exam done. Please give us 2-3 days to complete forms.
Additional Fees
Medical Records-$10 • Additional immunization copies- $2 • School Forms- $5 • Missed Appts – $25
| ATTENTION PARENTS IMPORTANT BILLING INFORMATION To avoid any misunderstanding concerning your medical bill and/or our payment policy please read the following information and feel free to discuss any questions you might have with our billing staff. Your health insurance benefits are determined by your policy. Please read your booklet carefully so that you are familiar with your insurer’s requirements for co-payments, referrals, or service requiring pre-certification. We will assist you in receiving the maximum benefit allowed for your child’s treatment here. Well Care Visits will address preventive pediatric exams and is not meant to diagnose or treat problems. If your child is covered under more than one policy, you must disclose that fact. Failure to do so can result in retroactive denial of claims with rescission of payment and you could be responsible for the entire amount of the claim. |
HMP/PPO/Medical Assistance Policies
In order for treatment to be covered, Dr. Qasba MUST be listed as your child’s Primary Care Physician. Failure to do so may result in rescheduling your appointment or parents will be responsible for any unpaid portions.
Insurance cards must be shown and co-payments must be made at each visit.
Divorce or Separation
We are not parties to your separation agreement/divorce decree. Payment for services is the responsibility of both parents.
Babysitters/Nannies
If you arrange to have your babysitter/nanny or grandparents, bring your child to the office, please make sure that you have provided us with a letter stating that they can authorize medical treatment for your child. Also, please make sure you provide them with your child’s co-pay, if applicable.
Forms of Payment
We accept cash, money orders, Master Card, or Visa at the time of service. You may mail a check if you are paying a balance received by mail. Returned check fee is $25.00.
“Quick Look” at Siblings
Quick look at a sibling when in with another child of the same family. If the doctor agrees to take a “quick look” at a sibling when seeing one of your other children, there will be a charge and/or co-payment for the second child if the second child’s chart is pulled, and our providers examine the child and a note is written in the chart.
Shot Appointments
If your child is scheduled for a shot only appointment, the nurse may administer the vaccine and answer questions about the vaccine being received. No other questions will be answered. If you have additional concerns please schedule a follow-up visit.
If you have any questions please speak to someone in the billing department. Thank you for your attention to these important matters.
Notice of Privacy Practices
This notice describes how medical information about your child(ren) may be used and disclosed. We are required by law to protect the privacy of your child(ren’s) protected health information. This document also explains how you can gain access to your child(ren’s) medical information and who to contact should you have a complaint.
Please read this document carefully and sign the acknowledgement form, found in the Welcome Packet.
