Twelve Oaks Pediatrics

​​​HEALTH INFORMATION REQUESTS

• HEALTH FORMS/ SPORTS FORMS/ IMMUNIZATION RECORDS:  We will be happy to fill out any health forms for your child, such as athletic and school physical forms. Please submit your request in writing (using the Health Information Request Form available in the office or on our website) or notify us via phone, and allow 5-7 business days for your form to be completed. We will call to let you know when it is ready to be picked up.  If you would rather have us mail or email your health form, please provide address information on the Health Information Request Form.  When possible, we will do our best to complete the health form during your visit with the doctor.  When picking up any medical records, health forms, doctor's letters, or prescriptions, you must present photo identification.  A charge of $10 will be assessed for each repeat form requested. If you are requesting a MHSAA Sports Physical Exam, please refer to their website for announcements and up-to-date information. Sport PE forms can only be completed if patient has had a physical exam in the last 365 days. 

• MEDICAL RECORDS:  Should you wish to acquire a copy of your child's medical records, you must submit your request in writing, using the Medical Records Release Form.  There is a $35 fee for records under 30 pages and a $50 for records 30 and over pages.  Payment must be made before the records will be released. Please allow 5-7 business days for your child's records to be sent. 

• LAB RESULTS: We will call the primary number we have on file as soon as we receive irregular test results from the lab. If the test results are normal, we will not reach out to you, "No news is good news!". We will note it in your child's medical record. 

PRESCRIPTIONS REFILLS

It is our policy that no new medications, including antibiotics, are prescribed without first being examined by one of our physicians.   For chronic conditions, we will be more than happy to refill your prescription, provided that we have been following your child for this condition.  ADHD medication refills require visits with the physician every one to three months.  Please contact our Prescription Refill Line (Option 4) for refill requests.  

REFERRAL REQUESTS

If you have an insurance plan requiring referrals from your PCP to obtain outside care or treatment, please contact our Referral Line (Option 5) with the following information: 

1. Patient name & date of birth

2. Parent name & phone number

3. Type of insurance & policy number

4. Reason for referral

5. Referred to physician (spelling of the physician’s first and last name) & NPI # if available

6. Referred to physician phone number, fax number, & address

7. Date of appointment

Please allow for 7 days to process your request.

APPOINTMENTS

• Patients under 18 must be accompanied to appointments by a legal guardian.

• NO SHOW POLICY: Missed appointments represent a cost to us, you, and to other patients that could have been seen during the time set aside for your child. Cancellations are required 24 hours prior to any well visit appointment and two hours prior to any sick visit appointment via phone call to the practice. A “No Show” fee of $25 will be applied if an appointment is missed and not cancelled within the stated timeframe.

• LATE POLICY:  Please arrive promptly for your scheduled appointment.  If you are new to the practice or need to update your personal/insurance information, please arrive 15 minutes prior to your scheduled appointment time so that we may input your new information and help keep your appointment on time.  If you are late for your scheduled appointment time, we may need to reschedule your appointment for another time.         

• WELL CHILD VISITS:  Well visits are scheduled 4-6 days after birth, 1, 2, 4, 6, 9, 12, 15, 18 months, 2 years, 2 ½ years, and once every 365 days thereafter.  A waiver must be signed for well visits scheduled prior to 365 after the previous well visit.  You will be responsible for any charges not covered by your insurance.  

• AFTER HOURS AND WEEKEND CARE POLICY: As a PCMH provider, we offer late-night appointments as well as weekend appointments. These services are offered as an alternative to more costly after hours visits to urgent care and the emergency room. Please be advised that these visits may be subject to additional fees through your insurance provider. 

• VACCINATIONS:  We now require patients to immunize according to the immunization schedule endorsed by the American Academy of Pediatrics. Please read more about our vaccination policy HERE. A legal guardian MUST be present to authorize the immunizations.  Once you have authorized immunizations, our staff prepares the vaccination for use.  If you DECLINE the vaccination once it has been prepared, you will be liable for the cost of the vaccine on the day of your visit.  We cannot bill your insurance company for ​wasted vaccines.  

PAYMENT AND INSURANCE

• CO-PAYMENTS/DEDUCTIBLES:  Many insurance plans require you to pay a co-payment and/or meet a yearly deductible.  Co-payments and yearly deductibles constitute a contractual obligation between you and your health plan provider. If the co-payment obligation is not met, your health plan provider has the right to deny any and all charges, which could leave you responsible for all services rendered during your visit. 

• PHYSICALS/OFFICE VISITS: If your child requires extra time during their physical to discuss concerns that are beyond the scope of a general physical, we will bill for the extra time as per the guidelines developed by the AMA and AAP.  In this situation, you may be responsible for an office visit co-pay. If more convenient, a separate appointment can be made to address these additional concerns. 

• PAYMENT POLICY:  Co-payments are due at the time of service.  We accept cash, checks, Visa, MasterCard, Discover and American Express.  Statement balances may also be paid through this website.  Click HERE for online payments.  

• INSURANCE PLANS: Each insurance plan is unique in its coverage, limits, and exclusions. We urge you to check with your health plan provider to find out what services are covered.  If a claim is rejected, please call your insurance company first.  PLEASE REMEMBER THAT IT IS YOUR RESPONSIBILITY TO KNOW YOUR INDIVIDUAL COVERAGE.

• NEWBORNS: Remember to add your newborn to your insurance as soon as possible within the first month. This does not occur automatically.  Please notify us once this is complete and we will bill your insurance for accumulated charges from the first few months.  You will receive a statement from us that may include charges that you are not responsible for until we receive verification that your newborn has been added to your insurance.  If your insurance is an HMO or requires you to select a doctor, please remember to choose one of our doctors as your PCP (Primary Care Physician) to ensure timely payment of claims.  

CONTACT US

• CALLS DURING OFFICE HOURS: We encourage you to call the office with your questions. Our billing department is available from 8:00 am to 4:00 pm, Monday through Friday.  For medical related questions, call us from 8:00 am to 7:00 pm, Monday through Thursday, 8:00am to 4:00pm on Friday.  You can talk to one of our medical staff or you may leave a message for your primary care doctor.  When you leave a message during office hours, we will do our best to get back with you as quickly as possible.

• MAIN OFFICE NUMBER: 248-347-8040
  Option 1:  Appointment Scheduling
  Option 2:  Location, Hours, Website 
  Option 3:  Medical Staff Line/Lab Results
  Option 4:  Medication Refill Requests
  Option 5:  Referral Requests
  Option 6:  Office Manager and Billing Questions     

• AFTER OFFICE HOURS CALLS: If your child becomes ill after office hours, and you cannot wait until the next day, please call our answering service at (248) 691-8683 and the doctor on call will contact you as soon as possible. While you are waiting for the doctor to return your call, please deactivate any call-blocking features on your phone. For privacy purposes, our doctors block their numbers.