Financial Policy


Thank you for choosing to receive your health care at our medical office! This page contains important information about your financial responsibility for services you receive. We want you to be informed about the costs of care and your obligations. Please be sure to ask any questions you may have.

  • It is your responsibility to inform Hampshire Pediatrics of any changes to your insurance coverage. YOU MUST BRING YOUR INSURANCE CARD TO EVERY VISIT. We want to have up to date information to get the billing correct from the start.
  • You will be responsible for any charges if your insurance is ineligible; if Hampshire Pediatrics (HP) is not listed as the primary care physician; if HP is a non-participating member with your insurance, or if services are not covered.
  • PAYMENT OF CO-PAYS ARE DUE AT THE TIME OF THE VISIT. Failure to pay co-pays at that time will result in a $20 administrative fee.
  • In divorce situations, the parent bringing the child in for care is responsible for the co-payment.
  • The office requires 24 hours notice for future appointment cancellations and 4 hours notice for appointments made within 24 hours of appointment time. There is a $20 charge for missing an appointment without adequate notice. If you miss three appointments, you may be dismissed from the practice
  • It is important to know what your health plan covers. Some may not cover routine childhood screening tests, for instance. Some services may be applied to your deductible. These determinations are made by your health plan, not Hampshire Pediatrics.
  • Self-pay: payment is expected at the time of service. We can usually tell you ahead of time what a typical visit will cost.
  • School absences: the office will provide documentation for the school only for the days that a patient was seen in the office.