Forms and Policies

Late Arrivals, Cancellations and No-Show Policy

Lafayette Pediatric Clinic appreciates being our patients’ provider of choice and we value their time. Appointment scheduling is designed to maximize the benefits patients receive when they see the provider and to ensure that each patient receives the attention they deserve. Adhering to the appointment schedule minimizes wait times and enhances the patient/provider experience.

Lafayette Pediatric Clinic understands that sometimes things happen. We request that patients notify the clinic as soon as possible if they are going to be late for an appointment. While every effort will be made to honor appointments, a patient who is MORE THAN 15 MINUTES late will be placed on the work-in schedule, which may significantly increase their wait time. If time does not permit, parents will be asked to reschedule.

Payment Policy

It is the policy of Lafayette Pediatric Clinic that payment is due at the time of service unless other financial arrangements are made in advance. We require all patients to pay their deductible, copay and/or coinsurance payment at each visit. At the conclusion of each visit, patients may be billed for any outstanding balances.

As a courtesy, we will verify benefits with our patients’ insurance companies (including Medicaid plans). We request that patients provide up to date insurance information prior to or at the time of the visit. Although we are contracted with many insurance carriers, we highly recommend that patients contact their insurance carrier for an explanation of benefits and verification of eligibility. Patients are responsible for all co/pays, deductibles, and co-insurance costs incurred when they are referred to specialty providers (including lab and imaging referrals).

Self or Private Pay patients should call our office prior to the visit. Our billing coordinator can advise what payment will be due for services.

Vaccines

Vaccinating children and young adults may be the single most important health intervention we perform as healthcare providers. Evidence strongly indicates that vaccinating children on schedule with currently available vaccines is absolutely in the best interest of personal and public health.

Lafayette Pediatric Clinic firmly believes in the safety and effectiveness of vaccines to prevent serious illness and to save lives. We firmly believe that all children and young adults should receive all recommended vaccines in a timely manner.

Lafayette Pediatric Clinic is committed to the health and safety of all the children it serves and requires vaccination of all its patients per the guidelines published by the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the World Health Organization.

We also acknowledge the importance of the patient/provider relationship; which is built on a mutual trust and commitment to treatment plans set forth by the provider. This commitment is integral to optimal care for each patient we treat. Parents who choose not to vaccinate (or who wish to vaccinate on a delayed schedule) will be asked to establish care with another provider whose views more closely align with their own. Lafayette Pediatric Clinic will provide treatment on an emergency basis until such care can be arranged.

Finally, we welcome the opportunity to answer any questions parents may have about vaccines and disease prevention. We are here to encourage healthy, informed choices for the patients and families we serve. It is our goal to be a valuable resource for information and support.

Insurance

• Acclaim

• Aetna

• Blue Cross Blue Shield 

• CHIPS

• Cigna

• Humana

• Golden Rule

• Magnolia

• Mississippi Medicaid

• Mississippi CAN

• United Healthcare

• TriCare (not Prime)

If you do not see your insurance listed, please call our billing office for assistance at (662) 236-3939.