Policies

Individuals at Einstein Pediatrics will not be discriminated against because of race, color, creed, religion, sex, age, sexual preference, national origin, citizenship, marital status, disability, veteran status, or any other status or characteristic protected under federal, state or local laws.

Acts of discrimination and/or harassment based on any of those factors are inconsistent with our philosophy and our core principles and will not be tolerated.

To ensure the protection of those in our office, particularly newborns and children who are immunocompromised and cannot be immunized, we require that patients keep up-to-date with the vaccine schedule published by the Academy of Pediatrics and the Centers for Disease Control (see below). Vaccinating children is a choice we hope all parents will make.  It ensures the safety of our community from vaccine-preventable diseases which have seen a resurgence in recent years.

The staff at Einstein Pediatrics adhere to the routine schedule with our own children because of our confidence in the safety and importance of immunization.  We are happy to discuss questions regarding vaccines to help you understand their importance and safety. 

For those choosing to not follow the recommended schedule, we will help you find another provider who better fits your family's needs.  It is our policy to only admit families to the practice who commit to the recommended vaccine schedule.   We reserve the right to discharge families who elect not to vaccinate or choose an alternative and non-evidence-based vaccine schedule.  

Please notify a staff member if you have any questions regarding the listed policies.  Policies may change in the future, but such changes will be made available to you prior to their implementation.  Einstein Pediatrics is a division of Trusted Doctors, LLC and bills are submitted through Trusted Doctors. 

Insurance

• Accepted Insurance: We participate in most insurance plans. If you are not insured by an eligible plan or do not have insurance, payment is expected in full at each visit. If you are insured by an eligible plan and do not have an up-to-date insurance card, then payment in full is expected at each visit until we can verify your coverage.
• Proof of Insurance: All patient families must complete our patient information form prior to an appointment with a medical provider. We must obtain a current copy of your valid insurance card for proof of insurance. If you fail to provide us with the correct insurance information at the time of service, you will be responsible for the full balance of the medical care administered during the visit.
• Insurance Coverage Change: If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If we cannot verify coverage, the balance will automatically be billed to you. 
• Newborn Insurance: In order for Einstein Pediatrics to file insurance claims for your newborn, a parent must add them to the insurance policy within 30 days of the date of birth. Once added, please notify our billing department so we can have the patient’s charges filed in a timely manner. If insurance is not determined after 30 days from the date of birth, the patient’s account will be considered self-pay and the responsible party will be billed for the balance.
• Co-payments and Balance Dues: All co-payments and balance dues must be paid at the time of service . This arrangement is set forth and enforced by your insurance company. Co-Pays not paid within 24 hours of the visit can incur an additional charge.
• Non-Covered Services: Please be aware that some or all of the services you receive may not be covered or considered reasonable or necessary by your insurance company. Since all insurance plans are different, please contact your insurance company or HR department for detailed information about what is covered or not covered including well-child visit maximum, immunizations, and in-office procedures. You will be billed and responsible for all non-covered services

Billing

• Claims Submission: We submit your claims to your insurance provider and provide reasonable assistance with receiving approval. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request .  Please be aware that the balance of your claim is your responsibility whether or not your insurance pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not a party to that contract.
• Monthly Billing Statement: After your insurance company processes the claim and sends payment to Einstein Pediatrics for rendered services, you will receive a monthly billing statement that indicates your balance (co-insurance, deductible) due. These amounts are payable to Trusted Doctors, LLC . The balance amount is to be paid in full within 10 days of receipt of the monthly billing statement. If you have questions about your account, please call 703-322-0245.
• Non-Payment: Partial payments will not be accepted unless otherwise negotiated with an employee at Trusted Doctors, LLC. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency.  You will be responsible for any collection or legal cost associated with collecting your account. If the bill remains unpaid, you may be discharged from this practice. If this is to occur, you will be notified that you have 30 days to find alternative medical care. During that 30-day period, our providers will only be able to treat your family on an emergency basis.
• Forms of Payment: Trusted Doctors, LLC accepts payments via cash, check, money orders, Visa credit/debit cards, and MasterCard credit/debit cards. Copayments and/or Account Balances are due at the time of service

Other Fees

• Missed & Cancelled Appointments: To respect the time of all patients and ensure appointments are available when needed the following charges will be billed directly to families.

1. $100 charge added to the account for any missed Well Visit appointment not cancelled within 24 hours of the appointment day/time.
2. $50 charge for any Sick Visit appointment not cancelled within 4 hours of the appointment date/time. Three missed appointments within a 12-month period will result in eligibility for discharge from the practice for the family.

• Out of Pocket Fees:

There is no charge for forms submitted at the time of the child’s well check appointment. When forms are requested on other dates necessitating an individual chart review, there is a

1. $10 fee for each form which will be completed within 5 business days
2. $30 fee for each form requested within 1 business day 
3. Einstein Pediatrics charges $20.00 for all after-hours phone calls . Both our portal messaging system (for non-urgent questions) and phone calls during office hours are free of charge.
4. Einstein Pediatrics charges $20 for any Copayments not received within 48 hours of the appointment.

We work hard to not overuse antibiotics.

We educate families on appropriate use of antibiotics, and follow evidence-based guidelines on prescribing antiobiotics. We will prescribe an antibiotic when we believe it is an appropriate treatment.

No antibiotic prescriptions or refills will be provided without the patient being examined in the office or sufficiently via telehealth.

ADD/ADHD Medication

Medications for ADD/ADHD are considered controlled substances.  If your provider prescribes medication to treat ADD/ADHD, the patient should be seen in the office at regular intervals of every 3 months to assess the efficacy of the medication as well as monitor for any potential side effects.  The provider will provide you with the appropriate prescriptions that will carry you over to the next recommended appointment.  We encourage families to schedule their follow-up visits at checkout to avoid disruptions in medication adherence.  

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Allergy and Asthma Medications 

If your child’s allergy or asthma symptoms are managed by our office and they have been seen recently our physicians can usually refill prescription medications such as rescue inhalers or inhaled corticosteroids.  If your child’s asthma/allergies are managed by another specialist (e.g. allergist or pulmonologist) or they have not required the medication in over a year, please make an appointment to have them seen by a provider. This will ensure that the dosing and frequency of the medication is correct and that your child is using the medication for the appropriate symptoms.

Medications Prescribed by Other Providers

If a medication is prescribed by another provider/office, and there is a lapse in care due to change of insurance or retirement, our providers may provide a prescription at their discretion but there is no guarantee that a provider at Einstein Pediatrics can prescribe a medication previously prescribed by another provider.  

Everyone's Time is Equally Valuable.

We ask that you arrive 5 minutes before your scheduled appointment time. We understand sometimes things happen beyond your control that may cause you to be late. However, we reserve the right to ask you to reschedule if you arrive late for your appointment.

Our practice makes every effort to run on time with appointments, as we believe everyone’s time is equally valuable.

Upcoming appointment reminders via phone/text message/email are sent in advance.

We reserve the right to charge a fee for canceled or missed appointments. We request 24 hours' notice for cancellation of well visit appointments, and 4 hours' notice for cancellation of sick/problem visit appointments.

A fee may be charged for a second missed appointment. The third consecutive missed appointment can result in discharge from the practice. Please reference our Financial Policy for fee details.

For new patients, a fee may be charged if the FIRST appointment is missed.

I. Purpose

This policy is to document the Trusted Doctors policies and procedures for sharing information with patients in a safe, secure and HIPAA compliant manner.

II. Manner

All information shared with patients and authorized representatives will be done so in a manner which is HIPAA compliant and in keeping with state and jurisdictional regulations regarding privacy, confidentiality and information sharing.

III. Goal

The goal of the practice is to make every effort to share information with patients and authorized representatives in order to empower them to be active participants in their care. Sharing of information will be accomplished through both active (upon request) and passive (information that is made available without explicit request) methods as outlined below.

IV. Active sharing of information

Trusted Doctors and the Divisions of Trusted Doctors makes every effort to honor requests from patients and authorized representatives to provide information to requestors in a timely manner and a format that is consistent with the request.

A. Requests

Requests from patients can be made to the practice via the following identified methods:

1. Portal message
2. Fax
3. In writing

B. Format

Trusted Doctors agrees to provide information to requesters in the following formats where possible and feasible:

1. Paper records (for mail or in office pick-up)
2. Faxed records
3. PDFs/Images/Documents provided on external hard drive/CD with appropriate encryption
4. Electronic information that is available electronically via a CDA may be provided by one of the following methods depending on the feasibility of the Division’s EHR system:

a. Via facilitation through a patient  portal

b. Direct Messaging to a trusted  third party in accordance with Direct Messaging protocols

C. Processing requests

All requests for information will be documented in the medical record within 2 business days of receipt and may include the following:

1. Name and role of the requester (if not the patient)
2. Time/date of the request
3. Written confirmation of request where feasible to document authority (may be signed information request form, portal message which required authentication to initiate, faxed or emailed documentation) 
4. Content to be included in the release of information per the request

D. Timely processing of requests

Every effort will be made to process requests within 10 business days in order to provide patients with timely access to their information. If Trusted Doctors is unable to meet the 10 day practice goal, the division staff will communicate an anticipated delay with the requester and make alternative arrangements to provide information (either in content or format) as mutually agreed upon. The practice will monitor their performance to ensure they are meeting this goal at least 90% of the time and institute improvement processes as deemed appropriate.

E. Cooperation and collaboration

If the practice is unable to provide the requested information in the manner and format requested, alternative arrangements will be sought to satisfy the requester. Documentation will be made in the medical record related to communication to offer alternatives and document resolutions. Any information that cannot be shared will be documented as to the content, the reason it could not be shared as requested, and will reference the appropriate exceptions according to the 21st Century Cures Act.

V. Passive Sharing of Information  

Trusted Doctors makes every effort to provide access to patient information via a patient portal hosted by a third party vendor.

A. Encouraging portal adoption

Trusted Doctors encourages use of the patient portal for all patients from the time of new patient registration and through individual invitation explaining the value of having access to clinical health information at all times.

B. Proactive sharing information through the portal

Trusted Doctors shares appropriate information freely through our EHR and Patient Portal technology wherever safe, appropriate and feasible via our technology partners.

C. Electronic Personal Health Information (EHI) currently available for patients or their authorized representatives in electronic format includes the following:

1. Demographics
2. Problem List
3. Allergies
4. Medications
5. Vital Signs
6. Visit Notes including Assessment and Plan
7. Procedures
8. Immunizations
9. Diagnostic Test Results
10. Smoking Status
11. Care Team Members
12. Implantable Devices The above EHI is available through both discrete elements of the patient portal and through self-generated CDAs which patients (or their representatives) can access freely through the portal.

VI. Ability to Receive EHI

Trusted Doctors makes every effort where feasible to receive patient information in an electronic format in order to empower patients to share EHI with our divisions to facilitate care delivery and the ability to reshare information electronically. This is accomplished with the providers participation in the Direct network. Patients and their authorized representatives, such as specialists and hospital systems, who have the ability to access their CDAs from other members of their care team, can access that information and share with us directly using our published Direct address.

VII. Gaps in Practice Information Sharing

Trusted Doctors makes every effort to share information in accordance with HIPAA, state and jurisdictional laws wherever possible. The following are identified gaps in information sharing and Trusted Doctors plans to address these gaps where feasible. The practice is committed to empowering patients with their health information and will work to continually identify and address gaps as they become known to us.

A. Information stored in non-electronic format

The practice has information stored as images and/or PDFs in our EHR as part of patient charts (including prior records, specialty reports from external sources). Since this information is not stored in an electronic format, it cannot be shared or transmitted in an electronic format. Patient requests for information which exist in these formats will be shared with patients in a mutually agreeable format as requested.

B. Sensitive data

1.  Pediatric charts can include sensitive information that is not directly patient data, such as health data specific to the maternal health history. In an effort to protect the maternal privacy in accordance with HIPAA, this information will not routinely be shared with others who may also have access to the information through a child’s medical records. As it is currently infeasible to redact the maternal history from the child’s medical records, some records may be protected. If this information is requested, the practice will document the request, attempt to reach a mutually agreeable solution with the requester and document the exception for sharing of information in accordance with the Information Blocking Provisions of the 21st Century Cures Act.
2. Other sensitive information regarding the health and well being of children and adolescents that is shared in confidence and in some cases protected by law. This is including but not limited to, suspected child abuse, gender identity, substance use/abuse, sexually transmitted disease treatment, pregnancy, HIV status, mental health. Sensitive and/or confidential information may be restricted from passive sharing due to provider concerns about harm to the patient or the infeasibility of being able to redact sensitive information as required by local, state or federal law including HIPAA. If this specific information is requested, Trusted Doctors divisions will document the request, attempt to reach a mutually agreeable solution with the requester and document the exception for sharing of information in accordance with the Information Blocking Provisions of the 21st Century Cures Act

C. USCDIv1

There are current sections of the USCDIv1 that have not been identified as data from our EHR which is sent electronically to the patient portal and its CDA functionality. We will remain educated and monitor our vendors’ functionalities to close those gaps as additional certification and information is available to the practice.

VIII.Non-discriminatory  Decisions to Withhold Information

Trusted Doctors does not make decisions to withhold information lightly. All decisions to withhold information will be done in accordance with the 21st Century Cures Act exceptions and in a non-discriminatory manner. The practice policy gaps in information sharing are outlined as above. In all instances, withholding of information will conform to this organizational policy or will be documented by a provider on a case-by-case basis

We leverage technology, including AI, to enhance care and communication. This includes, but is not limited to, our website, ele tronic health record, patient portal, and automated appointment reminders. 

There is no fee for the transfer of records when a family moves to another practice.

Self-pay accounts are patients covered by insurance plans in which Einstein Pediatrics does not participate, patients without an insurance card on file, or patients who do not have any insurance coverage. The parents shall pay in full at the time of service.

There is no charge for forms submitted at the time of the child’s well check appointment. Please plan ahead and have your forms ready at the well check.  If forms are requested at other dates necessitating an individual chart review, there is a $10 fee for each form which will be completed in 3-5 business days.  If the form is needed same day, there is a $30 rush fee. 

Einstein Pediatrics charges $20.00 for all after-hours phone calls. Both our portal messaging system (for non urgent questions) and phone calls during office hours are free of charge.  Our after hours line is answered by trained pediatric nurses who can answer most clinical questions.  There is always a provider on call available for emergencies to answer questions that the nurse is unable to answer.  As a division of Trusted Doctors we have also partnered with Hello Pediatrics to offer afterhours virtual visits.  These visits do incur a normal co-pay at the primary care rate.