Four Seasons Pediatrics

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Flu Vaccine, Form Fees and Deductibles

Flu Vaccine:

We wish to update you about this years flu vaccine.  This year Four Seasons Pediatrics has cancelled our order for Flu Mist vaccine.  We will only be offering Flu Shots for patients of the practice.  We learned of potency issues with the Flu Mist vaccine affecting the usefulness of the vaccine.  We were made aware of a possible issue related to proper temperature maintenance during shipping last fall of 2015.  At that time, we were informed that the lot numbers we were shipped were not affected.  It became apparent in early summer 2016, that the concerns with potency were more global than we were first made aware of.  As a result of a more extensive review, the CDC and the American Academy of Pediatrics recommended that the Flu Mist not be used until further research is performed on factors that led to the poor performance of the Flu Mist.  At Four Seasons Pediatrics, we will follow those recommendations and suspend use of this vaccine.  Despite these concerns, there were less Pediatric Deaths in 2015-2016 (85) than in the previous years (typically there are 100-200 pediatric deaths).  We have ordered more Flu Shots to immunize children in the practice.  Initial reports indicate that there will not be a shortage of vaccine.  We have already received flu shots for babies 6-35 months and anticipate delivery of a small order of shots for children 3 years and up within the next week.

Dr. Miller Comment: Original studies of Flu Mist indicated that it was more effective than Flu Shots.  The Flu Mist initially was shipped and stored frozen in a special Freezer Box to prevent defrost cycles from affecting the potency of the vaccine.  It was then engineered to be cold stabilized and stored in the refrigerator.   There is speculation that the vaccine may be more sensitive to temperature changes than previously thought.  It is also possible that previous doses of the Flu Mist may prevent the vaccine from being as effective when subsequent doses are given.  At this time, an intense review of all factors is being investigated, so that we can best protect children from the Flu.  

As always like previous years, we have a dedicated section on flu vaccine.  For information about flu vaccines click on the area called “About Immunizations” in the Other Pages area of our website (on the top left).  Then click on “Flu Vaccine Update” in the available list.  We encourage you to sign up for our newsletter in the newsletter section of our website, or click here.


Form Fees:

Dear Families:

In 2009, we began our current policy to charge form fees.   When Four Seasons Pediatrics was formed in 2001, we committed to and continue to provide more time during an office visit than most pediatric practices.  As a small, family owned practice, we do this in spite of not being able to negotiate with insurance companies or suppliers, as large practices do.  After careful review of form fees and review of all forms, our fees will be as follows:

$5 for forms noted below when requested NOT on the same day as a well exam

  • Well form (PE for school)
  • Daycare form
  • Medication form (daycare and school)
  • Allergy Plan

$5 PER PAGE for all other forms, including but not limited to:

  • College forms
  • FMLA forms
  • Adoption forms
  • Guardianship forms
  • Working papers
  • Boy/Girl Scout forms
  • Camp forms
  • Shen Methodist form (currently requires their own custom form)

$2 additional charge for forms requiring notary if done by our office; $10 if the provider needs to seek a notary outside the office.

A summary of our fees (Effective July 27th, 2016) are as follows:


  • Forms completed during a check-up: Four Seasons Pediatrics has developed computer generated forms.   These forms are developed from state requirements and meet the demands for almost all situations.  Forms generated from our system at the time of your child’s preventive exam will be given on request free of charge.  You will be given one copy.  Additional copies or a computer generated form at times other than while you are in the office during your child’s check up; will be charged a fee of $5 per form if picked up, $1 additional if mailed to your home.  Forms for siblings will also be charged this fee, unless they are requested at the time of their separate preventive exam.  School forms require an annual exam done within 12 months of the request.


  • Forms completed during a sick visit: Forms will be filled out at no charge if they are related to the sick visit (e.g. note to return to daycare/school/work, note to administer medication related to a sick visit) and they are requested at the time of the visit.   Additional copies or a request for a form not done while you are in the office at the time of the visit will be subject to a fee of $5 per page if picked up, $1 additional if mailed to your home. 


  • Custom Forms: While our computer-generated forms will be applicable for almost all school forms and daycare forms, there are some schools and daycares that require their own custom forms to be filled out.  The fee for custom forms is $5 per page if picked up, $1 additional if mailed to your home.  This fee applies for custom forms done at any time whether done at a check up or not.


  • Turn Around Time:  Although we usually accomplish these in a shorter time frame, please allow a turn around time of up to 2 business days for forms.  Please understand that at certain times of the year we receive hundreds of forms in one week.  Our nurse, PA and/or physician must carefully review each of these forms before it is released.  Please note that we do not fill out forms at the time of a sick visit, except as noted above.


  • Form Release:  Forms will be held here for parents to pick up.  Because of Health Insurance Portability and Accountability Act (HIPPA) regulations, forms will be released to parents only unless a signed consent is provided.  We will mail forms to the home address on file at your request, subject to the above fees.


High Deductible Plans:

As more families chose High Deductible Plans – we would like to review information that will help you understand these plans.

Important terms to know

  • Monthly premium The amount it costs you to have insurance
  • Benefits Services or care the insurance provides discounts for
  • Deductible amount The discounted amount you must pay a doctor’s office
  • Deductible limit The total you must pay overall before the insurance pays
  • Preventative care Services provided by a doctor that have no deductible (as determined by each insurer)
  • Office visit ANYTHING else not considered preventative by insurance
  • Allowed amount The discounted amount for care determined by insurance
  • Billed amount The cost the office bills the insurance for, not what you pay

What is a deductible?

There are a few different types of plans offered by most insurance. These plans can and typically do have exactly the same benefits as one another, just different in how much they cost you out of your paycheck every month and how much you pay a doctor when you are seen by one. The important thing to remember with deductible plans is you as the member or patient pay less every month to own the insurance, but more when you see a doctor until, you reach your limit. Once someone with a deductible plan meets their limit, the insurance typically pays for care up to 100% of everything going forward.

How does this work?

Consider the two examples. Jack and Jill both have insurance through the same employer. They have the same benefits but Jack has a deductible plan with a $1000 limit. Jill has a copay plan of $15.  Jack’s plan costs him $10 a month whereas Jill’s plan costs her $80 a month.  Jack and Jill both go to the doctor this month for a sore throat. Their doctor bills the insurance company $150 for the visit. The doctor and the insurance have a contract that allows this service to only $100, this is the allowed amount. Jack, having not yet met his deductible, needs to pay the full allowed amount of $100, as the insurance wont pay anything until he meets a total of $1000 paid for medical care.  Jill on the other hand only needs to pay the doctor $15 because she has a copay plan. The insurance picks up the other $85 of the $100, and pays that directly to the doctor.

For the first month, Jack has paid $10 for his insurance plus $100 towards the deductible making a total of $110. Jill paid $80 for her insurance plus the $15 copay totaling $95. Here you can see that Jill’s plan is less expensive, but do not be fooled.

Lets look at an example a few months later.

Again, Jack and Jill go to the doctor for sore throat again. Jill pays her usual copay of $15. Jack now has met his deductible of $1000 and .  . Jill however has to pay $15 for each and every visit.

What’s the catch?

Deductible plans are not for everyone if you have a choice. Using the example above, Jill knows with her plan she will only be paying a copay. Copay plans will usually have different amounts depending on where you go, such as your regular doctor, a specialist or a hospital, but she will always know what to pay. With Jack’s plan however, if he has not met his deductible, there are some services he could be seen for, such as going to the hospital, where he could pay a significant amount, if not all, of his deductible in one shot. With significant services, the insurance company allows a large amount on the provider’s contract, therefore making the patient responsible if the deductible has not been met. Jack will have to pay the doctor’s office until his deductible it met. An example could be where Jack and Jill both break their arm. The hospital bills their insurance $1500 for xrays, doctor evaluations, etc.  The insurance allows the hospital $1000 for the services due to their contract. Jill has a $100 hospital copay, so this is the only thing she will be paying and her insurance picks up the other $900. Jack has not yet met his deductible, and has $500 remaining to his limit. Therefore, because the allowed amount from the insurance to the hospital is $1000, Jack will need to pay the rest of his deductible, in this example $500, to reach his max. After he reaches his max, the insurance will pick up the other $500.

You may be asking yourself “Well why would I want a deductible plan if I have to pay that much for a doctor visit?” Deductible plans have a much lower monthly premium cost, but a higher risk of  unpredictable costs.  However, with a deductible plan,  once you meet your limit, like Jack did above, your out of pocket costs can go way down (depending on how your deductible plan is written) .

Let’s consider the last example.

Jack and Jill go to the hospital again because they broke their other arm. Jill has her $100 copay that she will pay a hospital every time she goes. Jack, having met his deductible limit, pays $0 per his plan. Jack also pays less for medical services after meeting the deductible limit. Deciding what plan you want if you have a choice is all about budgeting your medical spending.

Concerns about having a deductible

Some families may be hesitant about bringing their child in for care for fear of not meeting a deductible.  It may also put you in a position of declining a recommended test or treatment.  If you feel that this type of plan will create a problem like this, it may not be the best plan for you.  In any case please bear in mind the following:

  • Your insurance company determines how much you owe, not the doctor’s office.
  • No matter who you pay your deductible to, it all adds up and goes to your limit.
  • Your insurance contract states the doctor can ask for your deductible at the time of service.
  • Ignoring a bill for your insurance deductible can potentially lead to discharge from the medical office, but is also considered insurance fraud.
  • The doctor can not change this amount or write it off, this is fraud also
  • Most offices know what the allowed amounts are for certain billing codes with certain insurances. Feel free to ask what the deductible will be.
  • The insurance company has applied benefits to your medical visit, under the presumption that you, the patient, will pay the office. Therefore by their accounts, you have paid the office and fulfilled that amount towards the limit of your deductible, which is untruthful.  In some cases, doctors may contact your insurance company and inform them of this, and your insurance company could take action against you as the subscriber.
  • Don’t let worries of payment affect bringing your child in for a necessary visit.  Most offices will work with you regarding payment plans


Be aware of what kind insurance plan you have and exactly what your specific contract benefits are. Each and every insurance contract is different in some way even if through the same company. Some plans have what is called a co-insurance, which is usually a percentage of the allowed you owe the office.  Some deductible plans have a co-insurance after the deductible, but typically a very small amount. Only “in-network” offices and doctors are subject the allowed amounts and limits. Seeing an out of network doctor or office without approval means you will end up paying 100% of what the office charges. There are no allowed amounts and benefits will be limited. Your doctor’s office should be able to answer any questions you may have concerning your deductible, but not know about your specific contract guidelines or benefits. It is the subscriber’s responsibility to know what the insurance does and does not cover, not what the allowed amounts are.


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