Learn More About Our Office Policies

Parents know who they should go to when their child is sick. But pediatrician visits are just as important for healthy children. It is the expectation that our families will adhere to the schedule put forth by Bright Futures, the American Academy of Pediatrics, and the US Preventive Services Task Force.

Farmington Pediatric & Adolescent Medicine performs ALL Bright Future screenings, including behavioral health screens, labs, and hearing and vision screens. Although the Affordable Care Act has made these screens mandatory for most insurance companies, there are some insurers who are not bound to these rules. Check with your insurance carrier about what your policy covers.

Here are some of the benefits of well-child visits:

● Prevention. Your child gets scheduled immunizations to prevent illness. You also can ask your pediatrician about nutrition and safety in the home and at school.

● Tracking growth and development. See how much your child has grown in the time since your last visit, and talk with your doctor about your child’s development. You can discuss your child’s milestones, social behaviors and learning.

● Raising concerns. Make a list of topics you want to talk about with your child’s pediatrician, such as development, behavior, sleep, eating or relations with other family members. Present your top three to five questions or concerns to the pediatrician at the start of the visit.

● Team approach. Regular visits create strong, trustworthy relationships among pediatricians, parents and children. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop the optimal physical, mental and social health of a child.

As your pediatrician, we want to see your child for well visits on a defined schedule that has been shown to promote their health and wellness. This schedule, endorsed by the American Academy of Pediatrics, is defined by a program called "Bright Futures" and it is the standard of care to make sure that every child has their best chance for a bright future. During well visits, we monitor your child's growth and development, give appropriate immunizations, talk to you about important safety issues, and address your general questions and concerns. We also monitor for early signs of problems so that they can be identified and addressed appropriately.

Other reasons for a visit to our office might include an illness (such as a sore throat, fever, rash, abdominal pain, or ear pain), a specific concern (such as toe walking, not doing well in school, difficulty sleeping) or monitoring of a chronic problem (such as asthma, ADHD, diabetes, obesity, anxiety, or growth concerns). Whether this is a concern that you raise, or one that your pediatrician determines needs a follow up in order to provide good care, these are outside routine issues that are part of a standard well visit.

As your pediatrician, we must follow specific guidelines on what codes to submit to insurance companies to make sure that the care we give is appropriately processed by your insurance according to the terms and services of your policy. There are distinctly separate codes to describe what happens at well visits, and what happens at illness/concerns visits. Most of the insurance plans cover the basic codes for well visits without having you pay a portion of the bill. In contrast, most insurance plans require that the family has some cost sharing responsibility (co-pay, co-insurance, or deductible) for illness/concerns visits.

Sometimes we will allow you to "combine" a well visit with a sick visit for your family's convenience. For example, we may combine a well visit with an asthma or ADHD re-check. This convenience is often appreciated by our families in order to reduce missed school/work and other obligations. Due to the information that must be documented and sent to your insurance company, any family responsibility for payment that is part of your insurance coverage must be applied to the part of that visit that is not a routine part of routine well care. It doesn't matter whether the well visit and the illness/condition visit are done on the same day, or different days; any family payment must be collected as part of our contract with your insurance company. Some insurance companies will not pay for both items on the same day, and we may ask you to schedule separate appointments on separate days. If this is the case, you may want to discuss this issue with your insurance plan.

It is not uncommon for your pediatrician or you to identify an acute problem at the time of the well visit. For example, on the day of your child's well visit, they may wake up with a sore throat and fever. Or your child may have a mild cough that you are not concerned about, but when we hear wheezing it may be determined that treatment is necessary. If we address that acute illness at that visit, we must record it separately and use different codes to submit to your insurance company. In addition, you may ask us to freeze a wart or perform another procedure which may be applied to your deductible or trigger a co-payment/co-insurance. Those services that apply to the acute illness (perhaps performing a strep test and writing a prescription for an antibiotic) generate the same financial responsibility that would have been charged if you had come in for those complaints on a day different from your well visit.

Farmington Pediatric & Adolescent Medicine wants to partner with you to make sure that your child gets the most appropriate care. If you have multiple concerns that you wish to discuss at a well visit, ask us the best way to address those concerns. If your child wakes up ill on the day of a well visit, call our office so that we can make sure that we are able to appropriately address the illness as well as make sure that your child gets timely routine well care. Please know that as your pediatrician, we must follow the rules of your insurance plan and that often includes family payment obligations when combining care for illnesses or conditions at the time of the well visit.

Additionally, if you have an insurance plan that is "self-insured" by your employer, your insurance carrier may not be required by state law to cover essential services deemed necessary by Bright Futures and recommended by the American Academy of Pediatrics. These services are performed according to a pre-determined schedule, and may include vision and hearing screens and behavioral health or developmental screens.

If an emergency should arise, please call 911.

Emergencies are considered to be those conditions that are life-threatening: loss of consciousness, severe bleeding, seizure, etc. In the case of minor emergencies (lacerations, cuts, mild fractures, sprains), please call our office first for instructions.

The doctors take emergency calls from their homes after hours. Call the main office number, and our answering service will page a doctor to call you back. Please save routine questions (mild illness, appointments, prescription refills) for the morning. We encourage you to refer to our website first, when practical, before calling the office.

There may be times when our "Night Nurse" is the first person you reach after hours.

Night Nurse utilizes protocols and guidelines developed by Barton D. Schmitt, MD, FAAP, a leading authority and pioneer in Pediatric Telephonic Triage. Protocols span the spectrum of common conditions and ailments, representing 99% of calls received for telephone care advice. These protocols guide nurses in deciding which patients need to be seen immediately, who can be seen by appointment and who can be safely treated at home.

● We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives. ● We firmly believe in the safety of our vaccines.● We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP). ● We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities.● We firmly believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities.● We firmly believe that vaccinating children and young adults may be the single most important health promoting intervention we perform as health care providers, and that you can support as parents/caregivers.
The recommended vaccines and the schedule of administration are the results of years and years of scientific study and data-gathering on millions of children by thousands of our brightest scientists and physicians. The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results. Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR (measles, mumps, rubella) vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of under-immunization, there have been small outbreaks of measles and several deaths from complications of measles in Europe over the past several years. The United States experienced a record number of measles cases during 2014, with 667 cases from 27 states reported to CDC's National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000. Furthermore, we firmly believe that by not vaccinating your child, you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that a child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable. Even delaying or “breaking up the vaccines” to give one or two at a time over additional visits goes against expert recommendations, is not supported by any scientific data, can lead to unnecessary delays and errors, and can put your child, other children, and adults at risk for serious illness (or even death). It is therefore against our medical advice as professionals at Farmington Pediatric & Adolescent Medicine. As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We are more than willing to discuss any questions you may have about vaccines, but do require all new patients to our practice to adhere to the vaccination schedule endorsed by the American Academy of Pediatrics (AAP).

We believe that divorce, separation, and custody agreements should not interfere with a child’s medical care.

A parent requesting medical treatment is individually responsible for the payment of that visit’s medical bill. Farmington Pediatric & Adolescent Medicine is not a party to your divorce agreement; we will collect co-pays and deductibles from the attending parent, and will hold the attending parent responsible for any other payments associated with that visit.

“Joint Custody” means that each parent has equal access to the child’s medical record. Without a court order, we will not restrict either parent from access to their child’s medical information.

We will not call the other parent for consent prior to treatment, or to inform the non-present parent of the assessment and/or plan of care.

We will discuss information pertinent to the child’s history and exam with the accompanying parent at the time of the visit; it is the parents’ responsibility to communicate with each other.

If a court order requires us to do otherwise, we will be happy to comply after we receive a copy of it, which we will enter in the child’s medical records.

Should issues between parents become disruptive to our medical practice, we reserve the right to discharge a family from our care and responsibility.

Farmington Pediatric and Adolescent Medicine, LLC (hereafter identified as FPAM) implements a process to promote the adherence to an annual health maintenance visit.

Policy: FPAM requires ALL patients who wish to remain a patient of the practice to have an annual health maintenance visit by our providers. A visit at another institution will not satisfy this policy.

Procedure: FPAM uses the PCC EHR (Electronic Health Records) system to store all the medical information about our patients, and to communicate with our patients. We can run reports which identify our patients within the criteria. The Notify entity of our EHR system reminds patients automatically to schedule a health maintenance visit.

We utilize signed letters to inform patients of our requirements for their routine care. We advise patients that without their annual health maintenance visit we will no longer be able to provide the best medical care and therefore they will need to find another office.

At this annual visit, all paperwork for daycare, school forms, camp forms, asthma action plans, etc. is provided to the patient.

If the patient's insurance does not cover yearly health maintenance visit, our policy will adjust to reflect the standard set by their carrier.

Farmington Pediatric and Adolescent Medicine, LLC (hereafter identified as FPAM) implements a process to promote the adherence to chronic medication regime by our patients who have diagnoses which deem the need for this.  
Policy: FPAM requires ALL patients who have been diagnosed with asthma (acute, chronic, or intermittent) or ADHD (attention deficit hyperactivity disorder) to appropriately maintain their prescribed medication regime. This includes patients getting timely medication re-fills per schedule, as well as having follow-up visits as ordered by the provider. 
Procedure: FPAM uses the EHR (electronic health records) system to store all the medical information about our patients. We can run reports which identify our patients with certain diagnoses such as asthma and ADHD, to find out whether they have been refilling their prescribed medications as per schedule, as whether they have been for follow up visits as per MD orders. We expect you to schedule your next visit on your way out. Patient's medications are updated in the electronic record continually, The pharmacies send electronic requests for refills so we can track the patient's schedule of obtaining their medications. 
We utilize signed letters to inform patients of our requirements for their follow up medication assessments, re-fills and adherence. ● For asthma: updated prescriptions of corticosteroids inhaled medicine are required every 6 months along with a patient visit for an Asthma Control Test, Easy Breathing survey, spirometry if needed, and an Asthma Action Plan. ● For ADHD, anxiety and depression: updated prescriptions of their control medication are required every 90 days along with an office visit for patient assessment. 

Farmington Pediatric and Adolescent Medicine, LLC (hereafter identified as FPAM) implements a process to reduce the number of inappropriate Emergency Department (hereafter identified as ED) visits by our patients.
FPAM requires ALL patients who have been report to us as having had an ED visit to:1. Have a follow-up appointment in our office if recommended; OR2. Have a follow-up phone discussion if their health status is currently not acute. These patients include those who have one or more visits to the ED, not just "frequent" ED visitors
Policy: FPAM receives electronic reports of visits to hospital emergency departments. Our policy is to have every patient for whom we receive an ED visit report, to schedule a required follow-up with one of our providers, or have contact via phone with one of our medically trained staff to discuss the ED visit. This follow-up visit or phone discussion is to assess patient's post-ED health status, and to review reason for patient going to ED, and to determine if visit qualified as medically necessary. Teaching will be provided to patient/parent/guardian of minor, to clarify what health conditions are appropriate for use of ED, versus those that can be handled by our office. Patients will be reminded that we have phone coverage 24/7 via our main office line (860) 677-1112, through which treatment advice will be given via the provider on-call. Patients will be informed that there are urgent appointments available if the call comes in during regular business hours, and that after hours there often is an urgent appointment available with the provider on-call. It will be re-enforced that emergency care will be deemed necessary and advised by our providers. 
Of course when patients are experiencing true emergency situations they should call 911.
Procedure: within 24 hours (on working days) of receiving report from the ED, the practice's staff will make a follow-up call to patients and the following actions will ensue:● If patient's health status is no longer acute, then a phone discussion (as described in the above policy) will be completed and documented in the patient's EHR. ● If the patient's health status remains acute, then the patient will be given an appointment within an appropriate time fram in our office to assess and treat condition, and provider will engage patient in discussion of the appropriate use of the ED, and the availability of primary care provider for urgent medical concerns. ● If we do not have updated patient contact information, effort will be taken to ask the hospital for demographic records and/or other family members to obtain contact information so a follow-up can be done.

Many insurance plans have complicated rules regarding specialist visits and referrals. Even within the same insurance company, policies and procedures may vary from one employer to the next. It is impossible for Farmington Pediatric & Adolescent Medicine to know the details of every patient’s insurance plan.
When you need to visit another doctor or facility, it is your responsibility to know your specific benefits. If you are unsure, you can get more information by calling the member services number on the back of your insurance card. We recommend that you know the answers to the following common questions before you need them:● Where should I get bloodwork and other labwork done?● Where should I get xrays and other imaging studies done?● Do I need a referral to see a specialist?● What do I do if the specialist wants me to have additional labwork or xrays or therapy?● If I choose to see a specialist who is “out of network,” how much of the bill will I be responsible for?
If your insurance plan does need referrals, our office policy requires a minimum of two (2) business days to process a routine referral. We recommend that you do this as soon as you make an appointment with a specialist.
We cannot “back date” a referral. If you are seen by a specialist without a referral, we will not be able to process one after the fact. If you call us on the way to the specialist, we may not be able to process your request in time for your scheduled visit. You may be asked to reschedule the appointment if the specialist cannot verify that you have a referral in the system. If you need to see a specialist for a follow-up appointment, inquire if you will need an additional referral or if the original referral included a certain number of follow-up visits within a defined period of time.
If your child needs a referral for therapies including physical therapy, occupational therapy or speech therapy, it is likely that there will be limits to how many visits your plan will cover and specific locations that you must use for care.

At your well child visit you will be provided with a completed State of Connecticut school form, Health Assessment Record (HAR), and an immunization record for your child. In school aged children, we will also provide a State of Connecticut Camp form which is valid for 3 years. These may be used to satisfy requests for forms from schools, camps, or sports activities anytime within the next 12 months. Please complete all of the parental & patient sections of forms prior to your child’s visit.

We encourage you to make and hold onto multiple copies. When you receive a request from a school, camp or athletic organization, you should attach these copies to their request for medical information. All of the information that is needed to satisfy their requirements is included within these documents. Providing them to your school or camp should eliminate the need for you to forward a specific form to us and then wait for our office to complete your form(s).

We are providing you with this copy free of charge at the time of your child’s well exam.

If your camp or school will not accept the information in this format and you still need to have their form completed, there will be a $10.00 charge for each form. Payment is due when the forms are dropped off. We have a 7 day turn around time for forms.

Please understand that each separate form that we need to complete takes time both on the part of the staff to fill out as well as by our Providers to review, amend, and sign. To that end, we are hopeful that this minimal charge of $10.00 per form will not be an undue burden to you while allowing us to continue providing quality care we deliver with minimal disruption to our staff. All additional form requests will still require a week for completion.

Rush forms for same day will incur a fee of $20.00 and if we have to mail it back to you there is an additional $1 charge. Forms cannot be faxed.

College forms require a week for completion and there will be a $10 charge, regardless of whether they are presented at the time of a health maintenance visit.

We hope this policy will provide you with timely access to the medical information that you need for your child’s activities.

Sincerely,
Your Healthcare Team at Farmington Pediatric & Adolescent Medicine, LLC.