Vaccine Policy:
Our policy is that:
- We adhere to the AAP immunization guidelines.
- Children must receive all vaccines recommended by the AAP that are mandated for school entry by the State of Connecticut.
- Children must begin receiving their immunizations by age 2 months.
- We do not follow “alternative” vaccine schedules. Any parents who refuse to adhere to the AAP-recommended vaccine schedule without a medical reason to do so may be discharged from our practice following a 30-day written notice from Doctors’ Pediatric.
Do you need a prescription refill?
Effective immediately, we have updated the prescription refill policy.
- Please plan ahead, especially when it comes to vacations and holidays! ALL prescription refill requests will require at least 3 business days’ notice.
- Prescriptions for ADD/ADHD medication or any other controlled substance will only be refilled Monday through Friday by your child’s PCP
Please note: States are increasingly restricting our ability to send out-of-state prescriptions, especially controlled substances (i.e., ADD/ADHD medication). We echo your frustration with how this changes our ability to prescribe medication when your child is out of state. In order to prescribe the appropriate medication to our patients, we will need to send the prescription to a local pharmacy. Parents will then need to bring or mail the medication to their children. As many of you may know, doctors are not allowed to send more than 30 days of a controlled medication to local pharmacies. Express Scripts will allow a 90-day prescription. This may be an option to make this situation more manageable.
*updated October 2, 2024
18 and up:
Once our patients turn 18, by law, we are required to have a signed permission to speak form on file. This form must be completed and signed by the patient themselves. Parents, we understand that it may be frustrating when you call the office and are told that we need the signed form before a provider or nurse can speak with them, but this is the law and we must follow it.
Click HERE to print out the 18 & up HIPAA Release and Consent Form
*updated 5/18/2023
Record Release Policy:
The charge for copying records is $15 per child, payable up-front at the time of the request. We will make every effort to make the copies available as soon as possible but please know that, by law, we have up to 30 days.
Click HERE to print out the Record Release Form. Once you have completed the Record Release form, you can drop it off, fax it, or mail it. We understand that under certain situations you may need to email the form. Please call the office to obtain the email address to use.
*updated 7/19/2024
HIPAA Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
This Notice of Privacy Practices is NOT an authorization. This Notice of Privacy Practices describes how we, our Business Associates and their subcontractors, may use and disclose your Protected Health Information (PHI) to carry out Treatment, Payment or Health Care Operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. Please review it carefully. By signing the Acknowledgement form, you are only acknowledging that you received, or have been given the opportunity to receive, a copy of our Notice of Privacy Practices.
We reserve the right to change this notice at any time and to make the revised or changed notice effective in the future. A copy of our current notice will always be posted in the waiting area. You may also obtain your own copy by accessing our website at www.drspedi.com or calling the Privacy Officer at 203-762-3363.
Some examples of Protected Health Information include information about your past, present, or future physical or mental health condition, genetic information, or information about your health care benefits under an insurance plan, each when combined with identifying information such as your name, address, social security number, or phone number.
There are some situations when we do not need your written authorization before using your health information or sharing it with others, including:Treatment: We may use and disclose your Protected Health Information to provide, coordinate, or manage your health care and any related services. For example, your Protected Health Information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your Protected Health Information may be used, as needed, to obtain payment for your health care services after we have treated you. In some cases, we may share information about you with your health insurance company to determine whether it will cover your treatment.
Healthcare Operations: We may use or disclose, as needed, your Protected Health Information in order to support the business activities of our practice, for example: quality assessment, employee review, training of medical students, licensing, fundraising, and conducting or arranging for other business activities.
Appointment Reminders and Health-related Benefits and Services: We may use or disclose your Protected Health Information, as necessary, to contact you to remind you of your appointment, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you. If we use or disclose your Protected Health Information for fundraising activities, we will provide you the choice to opt out of those activities. You may also choose to opt back in.
Friends and Family Involved in Your Care: If you have not voiced an objection, we may share your health information with a family member, relative, or close personal friend who is involved in your care or payment for your care, including following your death.
Business Associate: We may disclose your health information to contractors, agents and other “business associates” who need the information in order to assist us with obtaining payment or carrying out our business operations. For example, a billing company, an accounting firm, or a law firm that provides professional advice to us. Business associates are required by law to abide by the HIPAA regulations.
Proof of Immunization: We may disclose proof of immunization to a school about a student or prospective student of the school, as required by State or other law. Authorization (which may be oral) may be obtained from a parent, guardian, or other person acting in loco parentis, or by the adult or emancipated minor.
Incidental Disclosures: While we will take reasonable steps to safeguard the privacy of your health information, certain disclosures of your health information may occur during or as an unavoidable result of our otherwise permissible uses or disclosures of your health information. For example, during the course of a treatment session, other patients in the treatment area may see, or overhear discussion of your health information.
Emergencies or Public Need: We may use or disclose your health information if you need emergency treatment or if we are required by law to treat you.
We may use or disclose your Protected Health Information in the following situations without your authorization: as required by law, public health issues, communicable diseases, abuse, neglect or domestic violence, health oversight, lawsuits and disputes, law enforcement, to avert a serious and imminent threat to health or safety, national security and intelligence activities or protective services, military and veterans, inmates and correctional institutions, workers’ compensation, coroners, medical examiners and funeral directors, organ and tissue donation, and other required uses and disclosures. We may release some health information about you to your employer if you employer hires us to provide you with a physical exam and we discover that you have a work-related injury or disease that your employer must know about in order to comply with employment laws. Under the law, we must also disclose your Protected Health Information when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements under Section 164.500.
Research: We may disclose your health information to researchers conducting research with respect to which your written authorization is not required, as approved by an Institutional Review Board or privacy board, in compliance with governing law.
SUD RECORDS DISCLOSURE AND PROTECTIONS
The confidentiality of your substance use disorder (SUD) treatment records maintained by this facility is protected by federal law and regulations (42 CFR Part 2 and the HIPAA Privacy Rule). Generally, we cannot disclose information that identifies you as a person with a substance use disorder to anyone outside the facility without your written consent. With your written consent, we may use and disclose your SUD information for treatment, payment, and health care operations. You may revoke your consent at any time in writing, except to the extent that we have already relied on it.
Use and Disclosure for Legal Proceedings: SUD treatment records from programs subject to 42 CFR Part 2 generally cannot be used or disclosed in legal proceedings against the patient unless there is specific written consent or a court order.
Redisclosure of SUD Records: If SUD records are disclosed with patient consent, the recipient can re-disclose them to contractors or legal representatives for specified TPO activities if a written agreement is in place that maintains confidentiality. Otherwise, redisclosure is prohibited.
SUD Counseling Notes: SUD counseling notes require a separate, specific consent for their use or disclosure and cannot be used or disclosed based on a general TPO consent.
Fundraising Communications: If SUD records are used or disclosed for fundraising, patients must be given a clear opportunity to opt out.
Exceptions: We may share information without your consent in a medical emergency, to report suspected child abuse as required by law, or to law enforcement if you commit a crime on our premises.
Stricter State Laws: If state law offers greater protection, the more stringent state law applies.
REQUIREMENT FOR WRITTEN AUTHORIZATION
There are certain situations where we must obtain your written authorization before using your health information or sharing it, including:
Most Uses of Psychotherapy Notes: when appropriate.
Marketing: We may not disclose any of your health information for marketing purposes if our practice will receive direct
or indirect financial payment not reasonably related to our practice’s cost of making the communication.
Sale of Protected Health Information: We will not sell your Protected Health Information to third parties.
You may revoke the written authorization at any time, except when we have already relied upon it. To revoke a written authorization, please write to the Privacy Officer at our practice. You may also initiate the transfer of your records to another person by completing a written authorization form.
PATIENT RIGHTS
Right to Inspect and Copy Records. You have the right to inspect and obtain a copy of your health information, including medical and billing records. To inspect or obtain a copy of your health information, please submit your request in writing to the practice. We may charge a fee for the costs of copying, mailing or other supplies. If you would like an electronic copy of your health information, we will provide one to you as long as we can readily produce such information in the form requested. In some limited circumstances, we may deny the request. Under federal law, you may not inspect or copy the following records: Psychotherapy notes, information compiled in reasonable anticipation of, or used in, a civil, criminal, or administrative action or proceeding, protected health information restricted by law, information related to medical research where you have agreed to participate, information whose disclosure may result in harm or injury to you or to another person, or information that was obtained under a promise of confidentiality.
Right to Amend Records. If you believe that the health information we have about you is incorrect or incomplete, you may request an amendment in writing. If we deny your request, we will provide a written notice that explains our reasons. You will have the right to have certain information related to your request included in your records.
Right to an Accounting of Disclosures. You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Right to Receive Notification of a Breach. You have the right to be notified within sixty (60) days of the discovery of a breach of your unsecured protected health information if there is more than a low probability the information has been compromised.
Right to Request Restrictions. You have the right to request that we further restrict the way we use and disclose your health information to treat your condition, collect payment for that treatment, run our normal business operations or disclose information about you to family or friends involved in your care. Your request must state the specific restrictions requested and to whom you want the restriction to apply. Your physician is not required to agree to your request except if you request that the physician not disclose Protected Health Information to your health plan when you have paid in full out of pocket.
Right to Request Confidential Communications. You have the right to request that we contact you about your medical matters in a more confidential way, such as calling you at work instead of at home. We will not ask you the reason for your request, and we will try to accommodate all reasonable requests.
Right to Have Someone Act on Your Behalf. You have the right to name a personal representative who may act on your behalf to control the privacy of your health information. Parents and guardians will generally have the right to control the privacy of health information about minors unless the minors are permitted by law to act on their own behalf.
Right to Obtain a Copy of Notices. If you are receiving this Notice electronically, you have the right to a paper copy of this Notice.
Right to File a Complaint. If you believe your privacy rights have been violated by us, you may file a complaint with us by calling the Privacy Officer at 203-762-3363, or with the U.S. Department of Health and Human Services, Office of Civil Rights. You may email the OCR at OCRMail@hhs.gov or call the U.S. Department of Health and Human Services, Office for Civil Rights toll-free at: 1-800-368-1019, TDD: 1-800-537-7697. We will not withhold treatment or take action against you for filing a complaint.
Use and Disclosures Where Special Protections May Apply. Some kinds of information, such as alcohol and substance abuse treatment, HIV-related, mental health, psychotherapy, and genetic information, are considered so sensitive that state or federal laws provide special protections for them. Therefore, some parts of this general Notice of Privacy Practices may not apply to these types of information. If you have questions or concerns about the ways these types of information may be used or disclosed, please speak with your health care provider.
*updated 2/12/2026
Financial and Billing Policies
Credit Card on File:
It is our practice policy to require all families to keep a credit card on file with us. This allows us to promptly collect the amount your insurance carrier says is your responsibility. Co-payments will be charged to your card on the date of service. Deductibles, coinsurance, and non-covered charges will be charged to your credit card upon receipt of the Explanation of Benefits (EOB) from your insurance company. Your credit card information will be kept confidential and secure as required by the PCI Securities Standards Council.
*This will go into effect on 3/18/2024
Co-Pays:
In accordance with our contract with your insurance company, we are obligated to take the co-payment defined by your insurance plan. Co-payment is due at the time of the visit by the person who brings the child to the office. For your convenience, we accept cash, checks, and all major credit cards.
*Effective 1/10/2024
Patient Balances:
As a courtesy to our patients, Doctors’ Pediatric will bill your insurance company. Please remember that your insurance is a contract between you and the insurance company, not the doctor. You are responsible for any charges or portion thereof for which payment is denied by insurance for any reason, except where prohibited by law or prior contractual agreement. A statement will be sent to the responsible party and is due upon receipt. Balances and/or unpaid claims after 60 days will be required to be paid in full or financial arrangements will have to be made before any future appointments can be scheduled. Please call our billing department immediately if you have questions about a statement you received or feel that there are any errors.
Unless other arrangements are made with our billing department, we may refer unpaid bills to a collection agency after 90 days. If your account is turned over to a collection agency, you will be responsible for any collection costs that are incurred. Once an account is sent to collections, a general discharge policy will take place. Remember that payment arrangements can be made at any point during this process prior to the account being sent to a collection agency. However, once this step has been taken, we cannot reverse the process of collections nor the discharge from the practice in general.
*Effective 1/10/2024
Services Rendered:
Non-covered services:
Not all services are a covered benefit in all contracts. In most cases, any non-covered service is your responsibility. Please take the time to understand the insurance plan you have and refer to our website for the schedule of well visits to see the services provided at each visit. If you do not understand your specific plan coverage, please call your insurance plan or your HR department at work. The number for your plan is listed on your insurance card.
*Updated 12/02/2025
Insurance:
Please be prepared to provide your insurance card to the front desk at every visit. All HMO plans require that you select your primary care provider. If the assigned Doctor’s name on your card is not one of our providers, your visit will not be covered. Please call the number on the back of your card to formally select our practice. If insurance coverage is not in place at the time of a visit, or if our providers do not participate with your plan, you will be responsible for paying in full with a cash discount.
It is your responsibility to inform us of any change in your insurance coverage. It is important that we have the correct billing information. If a claim is not received by your insurance company in a timely manner, they can deny the claim, making you responsible for payment.
*Effective 1/10/2024
Cancellations and Missed Appointments:
If it is necessary to cancel your appointment, please call the office and speak to a staff member AT LEAST 24 hours prior to the appointment. If you do not call, we cannot give that appointment to another child who may need it! Failure to cancel the appointment will result in a no-show charge of $75. The no-show charge for a missed sick appointment is $50. Emergencies will be considered on a case-by-case basis for a waiver of any fees.
As a courtesy, we provide text and email reminders of your scheduled appointments, however, you are still responsible for the cancellation even if you did not receive an email and/or text.
*Effective 1/10/2024
NSF Checks:
A $20.00 fee will be charged to your account for NSF checks that are returned by your bank. After two NSF checks have been returned on your account, we will request payment by cash or credit card only.
*Effective 1/10/2024
Health Forms:
We will provide your child with one school health form free of charge at their annual check-up. If you require additional/replacement forms, there is an administrative fee of $10 per form. There is a $10 administrative fee for each camp form processed. The fee is payable at the time of pick up.
*Effective 01/10/2024