Business Office Phone Number: 205-836-8691

To Become a New Patient:

• Call our office and let us know you would like to be a patient.
• You may have to speak with our business office to verify that we accept your insurance.
• We will ask that you request your child's records from their previous doctor. You can download a Transfer of Medical Records form that you can fax or mail to your child's prior doctor.
• Once we have received the records from your child's previous doctor, we can see your child for any visit.
• If your insurance requires you to declare a primary care physician for your child, please let your insurance know as soon as possible that you have changed primary care doctors to prevent any problems with insurance claims.
• You can download and print our Patient Demographic Form and Medical History Form to complete before you come to our clinic.

For Expecting Parents:

• We offer free expecting mother/parent site visits. This will give you the opportunity to visit our clinic, meet with one of our physicians and ask questions regarding our practice.
• Call our office to verify that we accept your insurance.
• When you deliver at the hospital, please inform them that your child will be a patient at Pediatrics East. The hospital will then notify us of your child's delivery.
• our pediatricians make rounds in the newborn nurseries at Brookwood Hospital and Vincent's Hospital Birmingham. If you have a baby at one of these facilities, our rounding physicians will examine your newborn and answer any questions you may have while in the hospital.
• If your child is in the Neonatal Intensive Care Unit (NICU) at any of these hospitals, the neonatologist at the hospital will be taking care of your newborn while he/she is in the hospital.
• If your child is born at a hospital where our physicians do not round, another physician (usually a neonatologist or pediatrician) will see your child while you are in the hospital.

We usually like to see your child in our clinic one to three days after being discharged from the hospital. The doctor that discharges you will make the determination on when you should bring your child to our clinic.

Insurances Accepted

We accept and are providers for most major insurance companies.

Payment/Financial Policy

Our primary interest at Pediatrics East is in taking care of your child. However, we must enforce our payment/financial policy in order to continue to provide your child the best care possible.

• We will routinely accept and file claims with most insurances. However, ensuring that your account is fully paid will be your obligation.
• Office visit fees/copays are due and payable at the time service is rendered. You will be expected to pay for your co-pay and payment for non-covered services at the time of your visit. We accept cash, personal checks, and credit/debit cards (MasterCard, Visa, Discover).
• If payment is not made at the time services are rendered, your account will be charged a $10 processing fee.
• You may be charged a $25 fee for appointments not kept without calling to cancel ahead of time.

  • Our policy (effective March 2013) states that if you miss three (3) appointments within one (1) year you will be dismissed from the practice regardless of the reason. To prevent having a no-show appointment, you must call the office at least 24 hours before your appointment when canceling or rescheduling

• Forms (e.g. school, camp, sport, WIC, certificate of immunization) not requested during an office visit will incur a $5 processing charge. There is a $15 charge for completion of "Family Medical Leave Act" (FMLA) forms. If a personalized letter is requested, an additional charge up to $20 (total charge) may be applied depending on the extent of the letter needed.
• You may be charged a $10 fee for non-emergent calls made after the clinic has closed. (Non-emergent calls are gladly answered during our after hours.)
• Statements for overdue accounts are mailed monthly.
• Accounts that are overdue for more than 90 days will be sent to a collection agency. At that point, you will be required to pay the account directly to the collection agency and any fees due to them.
• Once your account has been turned over to a collection agency, we may no longer be able to serve your child's needs at Pediatrics East. 
• Please notify our business office if you need to make special financial arrangements.
• Please notify us immediately if your insurance changes so that we may properly file your claims.

We accept payments online with a credit card (MasterCard, Visa, Discover). Click here to pay online.

Divorced Parents

Regarding services rendered to children from divorced or separated homes, the parent who brings the child to the office is responsible for making payment. Divorce decrees are between the parents and not Pediatrics East. Payment must be worked out between yourselves to keep your account in good standing.

Financial Assistance

You may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For Children’s Financial Assistance Policy contact 1-844-750-8950 or contact the Business Office at 205-638-2722. You can also visit Financial Assistance for additional information.

Non-covered Services

When you arrive at Pediatrics East, you will sign an agreement to pay for any services rendered that are not covered by your insurance. Because we deal with dozens of different insurances, we do not have the ability to keep track of what each individual insurance's coverage is. It is important to check with your insurance on what services are covered and what services are not covered by your insurance, especially routine immunizations, flu vaccine, and routine labs.

Forms

Patient Demographic Form
This form is for updating any personal information including address, contact phone numbers, insurance information, and emergency contact information. If any of this has changed, please fill out this form.

Medical and Family History Form
This form is for giving your child's medical history and any relevant family medical history. If you are a new patient or if any family history information has changed, please fill out this form.

Faxing of Information Release Form
This form authorizes Pediatrics East to fax medical information such as excuses, medication lists, and sports physical forms to any person or party (such as your child's school or your job) that you want information sent. No medical information will be directly sent to anyone other than a parent or guardian without this form completed. Please note that this is NOT a transfer of records form. If you are wanting to transfer your child's medical records from another doctor's office to our practice, please use the forms below.

Transfer of Medical Records

If you are requesting your records to be transferred out, please download the "Blank Transfer of Medical Records Form," complete the form, and either mail or fax the form to our office. Please note that for routine records request, requests will be completed within seven to ten business days. For urgent records request, we prioritize and process each urgent request on a case-by-case basis. Please complete and send the form to us, and contact our office if your records request is of an urgent nature.

• Transfer of Medical Records to or from the Trussville Office Form
• Transfer of Medical Records to or from the Deerfoot Office Form
• Blank Transfer of Medical Records Form

ADD/ADHD Information and Evaluation

What Is My Child Patient Portal

With our My Child Patient Portal, you can do the following:

• Update your child's personal information
• Request new appointments
• Ask non-emergent questions online to our nurse
• Request prescription refills
• Request forms such as immunization forms
• Receive email reminders of upcoming appointments

For all requests and nursing questions, please allow up to 3 business days for your request or question to be processed. 
If you need to be called today, please call our office, of if you have a medical emergency, please call 911.

Registering Your Child

To access your child's patient portal, you must be registered by Pediatrics East. To register, you must either request a registration in the office or call our office. Each child in the family must have a separate account. Once you have been registered by Pediatrics East, you will receive an email confirmation with a username and temporary password. Please allow 24 hours for your account to be activated once your child has been registered.

Accessing Your Account

To access your account, you will need the username and password sent to your email upon registration.

Go to My Child Patient Portal to login.

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