Phone: 203-227-3674 | 156 Kings Hwy North, Suite 3, Westport, CT 06880
Caring for your children from birth to college since 1978

Camp and Sports Forms Policy

It’s camp and sports form season!

During the spring and summer we have an abundance of requests for camp and sports forms to be completed.  We receive many, many forms per day and it’s an all hands operation to get them completed in a timely fashion.  We work on these in between patients, our regular duties and well into the night.  The price this year is $10 per form.

Here’s what you can do to help

Please allow a week to 10 days for your form to be completed.  If you know your child is going to camp or needs a sports form, don’t wait to bring us the form!

Make sure your portion of the form is completed before you bring it to the office; that will save time since we cannot complete our portion without it!

Please provide a list of any medications with dosages that your child will be taking at school or at camp so we can confirm that nothing has changed from our records.

It takes time

We do the best we can to get these done for you.  Please do not ask for forms to be completed sooner.  Unfortunately, they cannot be done today or while you wait.  We know that you want your forms completed accurately and understand that that process takes time.

As always, thank you for choosing Bay Street Pediatrics for the care of your child.

Fees to Avoid

You can avoid all of these fees with a little preparation.

  1. Have your copay and
  2. Have the correct and current insurance card for the child being seen

It’s that simple.  This will save us all time and money.

Forgot your copay:  $25

Copays are due at the time of service per your insurance contract.  Make sure you have a method of paying when you get to our office.

If we have to bill you for your copay there will be a $25 fee for this service.

You can avoid this fee by calling us on the same day with a credit card payment for your copay and we will waive the fee.  You can do this either before or after the appointment, whichever is convenient. This may be a good option if you are sending someone else with your child to our office.

Returned checks:  $20

Be sure to use the correct account when writing checks.  If a check is returned to us from the bank you will be charged $20 in addition to the amount of the check.

Wrong insurance information provided:  $20, potentially an additional $75 greater than 30 days

Unfortunately, people just do not take this seriously and get aggravated when we ask them about their insurance.  However, providing us with the wrong insurance information is the same as writing a bad check and is handled in the same fashion.  There is a $20 fee for denied insurance due to the insurance not being in effect at the time of the service.  This fee is in addition to the cost of the service.

Further, to resubmit these claims is very time consuming and there is a $75 fee to cover the cost of labor for resubmission.  We will absorb that cost if we receive the correct insurance information within 30 days of the date of service.  If it is after the 30 days and you wish us to submit the claims with the corrected information you will need to pay the $75 up front.  Claims cannot be submitted greater than 90 days past the date of service; you are responsible for the cost of the services denied.

Divorced or Separated Parents

You may have an agreement regarding the cost of health care for the children with the other parent.  That agreement is between you and we are not a party to it.

The parent who brings in the child and is requesting service is the parent who is responsible for the bill and is considered the guarantor.  This may be different from the primary insurance holder.  However, there is only one guarantor and unfortunately, we can only bill one person.  Any cost sharing arrangements will need to be done outside of our office between the parents.

For instance, if you are the guarantor and the other parent is responsible for 30% of the cost of health care you will need to pay the office in full and collect separately from the other parent.  We cannot bill the other parent for the balance.  We can accept payments from multiple people for the account, but the bill for any unpaid balance will only go to one person.

Bay Street Pediatrics

  • We have walk-in hours

    Our walk-in hours are meant to address acute, quick problems only. Long term medical or behavioral issues are better addressed during a longer scheduled appointment.

    Walk-ins 8:00am – 9:00am on Monday - Fridays.

    Evening walk-in time is Monday - Thursday from 5:30 pm - 7:00pm.
  • Regular Office Hours

    • Monday - Thursday
      9:30am – 5:00pm
    • Friday
      9:30am – 6:00pm
    • We also are available on Saturday mornings; please call after 8:00 am on Saturday to make an appointment.
  • Who can help me after hours?

    Our Pediatric Nursing Advice Line is available any time the office is closed to answer your questions and our doctors are on call to provide urgent care for you. Just call our regular office number (203) 227-3674. If you feel that you have an emergency please call 911. Please save non-urgent questions, requests for appointments, prescription refills, referral requests and other non-urgent matters for office hours.