We LOVE delivering pediatric care and enjoy the personal relationships we have with our patients and families. We must however charge for these services and expect reasonably prompt payment. That way, we can continue to “be there”, whenever you need us. Below is a list of our billing policies that will help us continue to deliver the highest quality medical care that you deserve:


-Copayments, coinsurances, deductibles, and any charges for non-insurance covered services should be paid at the time of service.

-You may charge any balance to your credit card (MasterCard or Visa). We encourage families to authorize Upper Valley Pediatrics to charge a credit card for balances that appear on their children’s accounts. Authorization forms are available by clicking here (text link to Credit Card Authorization form). Simply print the form out, fill in your information and mail it, fax it, or bring it with you to your next appointment.

-Let us know if your family is under significant financial hardship. Payment plans can be arranged if necessary. We want to be sure that your family receives the care you need and deserve.

-We must have updated confirmation of your insurance and identifying information at every visit. It is your responsibility to let us know of any changes in insurance data, addresses, telephone numbers, etc. and to assure your insurance policy registered with UVP remains updated and active.

-We will bill the insurance company you designate for the services we provide. If we do not receive payment from your insurance company within 60 days, the balance transfers to your responsibility. You will be notified about any unpaid amounts

-If balances not covered by insurance remain unpaid by you after 60 days notification, we may need to reschedule routine checkup appointments.

-Fees for forms and requested physician letters are payable when the forms are presented to the office (at our desk, or enclose check if mailed). Please pick up forms at our desk, or include a self-addressed stamped envelope if you want the forms to be mailed. Please allow three days to process routine forms

Fees are:

Brief or limited forms (i.e. lead form, immunization form or over-the-counter medication form only): $3

There is no charge for prescription medication authorization forms

-Missed appointments: We do charge for missed appointments.There is a $25 fee for routine appointments missed. There is a $50 fee for missed that are scheduled for 30 minutes or greater. Late arrivals may need to be rescheduled.

-Telephone Care charges: Upper Valley Pediatrics will submit a charge to all participating insurers for telephone services in which the physician’s decision-making skills and advice are provided by phone instead of via an office visit. Examples include telephone consultations for chronic health conditions, educational or behavioral issues, new prescription medications, and recommendations regarding diagnostic or treatment strategies.