POLICIES

The following three forms must be filled out by all patients once a year.

  • Vaccine Policy

    The health and well-being of your children are our top priorities. We firmly support the expert guidance and recommendations provided by leading health authorities, including the American Academy of Pediatrics (AAP), the Centers for Disease Control and Prevention (CDC), and the Advisory Committee on Immunization Practices (ACIP). As such, our vaccine policy aligns with the evidence-based immunization schedule developed by these organizations.


    We believe:


    • Vaccines save lives. Immunizations have been proven to prevent serious illnesses, reduce the spread of contagious diseases, and protect vulnerable populations.
    • Vaccines are safe. Extensive research and rigorous safety standards ensure that vaccines are both effective and secure for children and young adults.
    • Vaccines protect communities. By vaccinating according to the recommended schedule, we help prevent outbreaks and protect individuals who cannot be immunized, such as infants too young for certain vaccines or those with certain medical conditions.

    Our Policy Highlights:


    • Recommended Schedule: We follow the immunization schedule endorsed by the AAP and ACIP because it has been carefully developed to provide the best protection at the most appropriate times.
    • Evidence-Based Approach: Our recommendations are grounded in the latest medical research and data, reflecting a strong consensus among pediatric and public health experts.
    • Transparent Communication: We are always available to discuss any questions or concerns about vaccines and are committed to providing clear, respectful information about the benefits and potential risks.

    We understand that deciding how to protect your child’s health is one of the most important decisions you’ll make. By following this policy, we aim to ensure that every child in our care has the opportunity to grow up healthy, safe, and protected against preventable diseases.

  • Antibiotic Policy

    We work hard to not overuse antibiotics.


    We educate families on appropriate use of antibiotics, but follow evidence-based guidelines and don’t automatically treat ear pain or a green snotty nose with antibiotics.


    We do not routinely prescribe antibiotics over the phone as we do not believe that is good medicine. We will prescribe an antibiotic when we believe it is an appropriate treatment.

  • Appointment Policy

    Everyone's Time is Equally Valuable.


    We value your time and the time of all our patients. To help us provide timely and efficient care, please review the following appointment policies:


    Arrival Time

    We ask that you arrive 15 minutes prior to your scheduled appointment.

    We understand that delays can happen; however, if you arrive late, we may need to reschedule your appointment to avoid impacting others.


    Timeliness Matters

    Our practice strives to run on time because we believe everyone’s time is equally valuable. Please help us maintain this commitment by arriving on time and notifying us of any changes in advance.


    Appointment Reminders

    You will receive reminders for upcoming appointments via phone, text message, or email.


    Missed or Canceled Appointments

    Missed appointments take away valuable time that could be used to care for other patients. We request at least 24 hours’ notice for any cancellations.

    • A fee may be charged for missed or late-canceled appointments.

    • A second missed appointment may result in an additional fee.

    • A third consecutive missed appointment may lead to discharge from the practice.

    • New patients who miss their first scheduled appointment may also be charged a fee.


    Multiple Children Appointments

    If appointments for multiple children are missed or canceled, we may limit future bookings to one child per visit to help ensure appointment availability for all families.


  • Financial Policy

    CCH Pediatric Clinic P.C. (“CCH”) adheres to the American Academy of Pediatrics standard of care for all evaluations and treatments. If your provider determines that a service or evaluation is medically necessary, it will be performed regardless of insurance coverage, and you will be responsible for any non-covered costs. Because insurance plans vary, CCH cannot guarantee coverage for specific services. Providers base medical decisions on the best standard of care, not on individual insurance benefits.


    You are responsible for providing CCH with accurate and updated information, including insurance cards and contact details. Any changes must be reported to CCH promptly.


    Payments & Insurance

    • Co-pays and deductibles are due at the time of service. If you are unable to pay, your appointment may be rescheduled.
    • If you are uninsured or out-of-network, payment is required at the time of service unless CCH has approved other arrangements in advance. CCH accepts Visa, MasterCard, and Discover.
    • If your insurance requires a referral or prior authorization, you must provide it before or at your appointment. Without it, your visit may be rescheduled, or you must be prepared to pay in full.
    • As a courtesy, we will attempt to file your insurance, but you are responsible for any co-insurance, deductibles, or non-covered services, which must be paid within 60 days of claim processing.
    • If you cannot pay in full, you must contact CCH’s billing office at (402) 205-5632 to arrange a payment plan. Any payment plan will require regular minimum monthly payments (for example, minimum payments of $50 per month). You acknowledge that any payment plan is not an extension of credit. Failure to maintain your minimum payment requirement will result in your account being sent to collections. 
    • CCH does not intervene in disputes related to divorces, legal separations, or third-party litigation, and such matters do not exempt you from timely payment.
    • If you fail to update your address or contact information and CCH is unable to locate you, CCH will immediately refer your account to collections.

    Billing & Collection Process

    1. You will receive an initial statement requesting payment. If you are unable to pay the amount in full, please contact CCH’s billing team  at (402) 205-5632 to make payment arrangements. 
    2. Statements will be sent on a monthly basis for balances of $3.00 or more.
    3. If the initial statement is unpaid, a second (past due) notice will be sent.
    4. If no payment is received, a final notice will be sent with a 15-day deadline before your account is referred to a collection agency.
    5. If no payment is received within the 15-day deadline, your account will be turned over to a collection agency and all payments must be made to the agency. If your account has been turned over to collections, you will have 30 days to find a new provider and you will no longer receive treatment from CCH except under the following conditions: you have made specific payment arrangements and any visits during the 30-day period will be on a cash-only basis and payment must be made in full before receiving treatment.

    Lab Services

    If your insurance requires labs to be processed at a specific facility, you must inform staff at the time of service. If not, you will be responsible for any charges. Lab specimens collected by CCH are processed at Columbus Community Hospital, unless other specific arrangements have been made.


    Communication Consent

    By providing your contact information, you expressly consent to receiving calls, texts, and emails (including automated and pre-recorded calls) from CCH and its agents regarding appointments, billing, and collections, including to any cellular telephone numbers you provide, and you acknowledge that such communications may be subject to standard message and data rates from your carrier. If your phone number changes, you must notify CCH immediately. 


    No-Show Policy

    • 24-hour notice is required for cancellations or rescheduling.
    • Missed appointments without notice incur a $25 no-show fee, which is not billed to insurance.
    • Three (3) no-shows may result in dismissal from the practice.
    • CCH understands emergencies happen and will review situations as needed.

    Insurance & Claim Processing

    • CCH will attempt to code claims for your services and handle them as follows:
    • If CCH has a contract with your insurance company, CCH will file claims in accordance with that contract.
    • If no contract exists, CCH will attempt to file claims as a courtesy, but you remain responsible for any unpaid balance, including uncovered services or disputed evaluations.
    • If your insurance company does not process your claim within 45 days, CCH will attempt to follow up with your insurance company for status updates on your claim.
    • If a claim is processed incorrectly, CCH will attempt to resolve the issue in a timely manner.
    • Overpayments will be handled per CCH’s Patient Refund Policy.
    • CCH will answer all account inquiries honestly and work to resolve any issues promptly.

    Additional Terms

    • CCH reviews fees annually based on Health Care Finance Administration and American Medical Association guidelines. CCH’s fees are adjusted to align with acceptable ranges of CCH’s contracted, and most other, insurance company ranges.
    • Modifications to this policy require approval from CCH’s Financial Controller, Practice Administrator, or their designee. Nothing in this paragraph precludes CCH from settling legal disputes or pursuing CCH’s rights regarding medical liens or assignment of benefits.
    • For questions about CCH’s financial policy, please contact CCH at 402-564-7200.
    • For Billing questions please call (402) 205-5632.

    Please see the attached form to complete signature. 

  • Notice of Privacy Policy (HIPAA)
  • Technology Policy

    Efficiency Through the Use of Technology


    To better serve you and streamline your experience with our practice, we encourage the use of the following technology tools:


    Visit Our Website: Our website is a helpful resource for patient forms, office policies, and general information. Accessing these tools in advance can help reduce time spent at check-in and ensure you're prepared for your visit.


    Patient Portal: We highly recommend registering for and using our secure patient portal. It allows you to:

    • Access medical records
    • Send and receive messages securely
    • Request appointments and prescription refills
    • Using the portal helps protect your child’s privacy while giving you convenient access to important information.

    Automated Reminders: Our office uses automated phone, text, and/or email reminders to:

    • Confirm upcoming appointments
    • Remind you of routine care and immunizations that may be due
    • These tools help keep your child’s health on track and ensure nothing is missed.

    By embracing these technologies, we’re able to deliver more efficient, secure, and personalized care.

  • Telephone Policy

    Our scheduling and triage nurse is available on weekdays from 8:00 AM to 4:30 PM.

    Please call (402) 564-7200, option #4.



    If the nurse is assisting another caller, please leave a message with:

    • Your child’s full name

    • Date of birth

    • Reason for your call

    She will return your call as soon as possible.



    Please note: Messages left after 4:00 PM may not be returned until the following business day.


    More Information