PATIENT FINANCIAL POLICY
Thank you for choosing Kids Center for Pediatric Therapies as your child’s treatment service provider. We are
committed to providing you with the best possible care. Your clear understanding of our financial policy is
important to our agency/family relationship.
We must emphasize that, as medical care providers, our relationship is with you and not with your insurance
company. We cannot accept the responsibility of negotiating the claims with insurance companies or any other persons. While the filing of insurance claims is a courtesy that we extend to our patients, all charges are your responsibility from the date of the services rendered.
Your insurance coverage is a contract between you and your insurance company. It is very important that you
understand the provisions of your policy. We cannot guarantee payment of claims. If your insurance company
pays only a portion of the bill or rejects your claim, any contact or explanation should be made to you, their policyholder. Reduction or rejection of your claim by your insurance company does not relieve you of your
financial responsibility. Please remember that professional services are rendered and charged to the patient, not the insurance company.
I understand and agree that if any insurance company requires a referral from my primary care physician prior
to receiving services at Kids Center, it is my responsibility to obtain the referral and give prior authorization
numbers to Kids Center. Referrals and/or prescriptions may be faxed to Kids Center at :
Central Campus: (502) 635‐1147
East Campus: (502) 589‐2409