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Thank you for choosing Trophy Club Pediatrics. In order to help familiarize you with our office policies and procedures, we are listing them below. If you have questions, we encourage you to contact us. We look forward to seeing you!

Confidentiality

The Clinic and Health Professionals each are required by law to maintain the privacy of your health information (“Protected Health Information” or “PHI”) and to provide you with this notice of legal duties and privacy practices with respect to your Protected Health Information. The Clinic and Health Professionals use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. When the Clinic and Health Professionals use or disclose your “PHI”, the Clinic and Health Professionals are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure). Your health information is contained in a medical record that is the physical property of Trophy Club Pediatrics.

Patient Appointments

We see patients from 0 – 18 years of age. Once 19 years of age, patients are referred to physicians that care for adults. Patients are seen on an appointment basis. You may call the office during normal business hours to schedule an appointment, or schedule your appointment online. Our office number is (817) 400-1571. Please be aware that patients who arrive more than 10 minutes late for their appointments may be asked to reschedule.
If you have a scheduled appointment time and need to reschedule or cancel, please notify our office at least 24 hours prior to your appointment during our regular clinic hours which are from 9AM-5PM Monday to Thursday and 9AM to 2PM on Friday. We will gladly reschedule a more convenient appointment time for you. If you do not show up for your appointment, you will be charged a $25 no-show fee, multiple no-show will result in discharge from the practice.

After Hours

 
To improve access to care, our clinic offer After Hours appointments which are from 5PM-6PM Mon-Thursday. Scheduling an after hour appointment will result in an additional charge. Most insurance companies that we are contracted with pay this fee. However check with your insurance as this fee maybe applied towards your deductible or co-insurance.

Sick Care During a Well Exam

If in the course of a patient’s well exam a non-well issue presents which needs to be addressed, the office staff will schedule a separate visit. This includes ADHD, asthma, and any other disorder. If addressed at the time of the current well exam, an additional E&M code (evaluation and management) will be added to the visit. Your insurance company may require payment towards a co-pay or deductible since it is not covered in a well exam.

Holidays

The office is closed on Saturday, Sunday and all major holidays. For medical care during those times, patients are encouraged to use urgent care. For Emergencies please dial 911 or go to the nearest ER.

Inclement weather

For the safety of our patients and staff, the clinic is closed during inclement weather. As a general rule we follow the local school district closure as a guide. So if the schools are closed due to inclement weather the clinic will be closed. 

Vaccines

Trophy Club Pediatrics believes in the effectiveness of vaccines, and strongly recommends patients receive state and school mandated immunizations. Visit the CDC website for recommended vaccinations for your child.

Telephone Calls

Our office staff would be happy to answer your questions over the phone during normal business hours. Please be aware that the physician may be occupied at that moment with other patients. We will be able to take a message and relay it over as soon as possible.
Please limit after-hours calls to urgent problems. We ask that you do not call after hours to reschedule any appointments.

Prescription Refill Requests

If you need a refill on your medication, we ask that you place a request through your pharmacy, the patient portal, or call during office hours at least three days before you require the refill. The physician may need to see the patient prior to authorizing a prescription refill. We do not refill medication after business hours or on the weekends.

School/Camp/Office Forms

All forms will be completed within 3 business days. If you are coming in for a school physical bring your completed form.

USCIS - Immigration Exam

We offer the USCIS medical examination. We charge $300 (paid cash/credit card on first day of service). This fee covers your examination only. Your USCIS examination may require additional laboratory/radiological tests and catch up of immunization. The cost for these  will be in addition to the $300 paid for the examination. For more information visit https://www.uscis.gov/green-card/green-card-processes-and-procedures/immigration-medical-examinations/finding-medical-doctor

For your appointment - Print the most recent I-693 form from USCIS website and follow the instructions. Bring this form and your vaccine records.

Medical Records Release

To maintain patient confidentiality and assure compliance with federal and state privacy laws, health information may not be released without a patient’s written authorization (except as permitted by law). The information below describes the process of requesting medical records that you may have at Trophy Club Pediatrics. The steps involved depend on what records you want provided and/or to whom you want your records provided. Signed authorization forms must be submitted in person, by fax, or via mail.
In Person: Drop off the signed form at the front office and we will fax your information out. Our Request for Medical release form is located here

By Fax: 855-298-3967

By Mail:
Trophy Club Pediatrics
Attn: Medical Records
2213 Martin Drive Suite 200 Bedford TX 76021

For Personal Use

You can download, save or transmit your record via the patient portal, otherwise a signed and completed authorization form is required if you want records sent from the office.
Medical record released to patient will result in a flat rate of $6.50. (Getting your records from patient portal is free)

For medical record release to third party, there will be a $25.00 fee for the first 25 pages and an additional charge of $0.15 per page copied.
All mailed records sent via certified mail carry an additional $4.00 fee.
Records may be picked up by the patient, or they may be faxed, or sent via certified mail.
After we receive your completed authorization form, you will be notified of the total cost to prepare a copy of your records.
Your request will be processed upon receipt of payment, with a timeline of up to 15 calendar days to process the request.
For an Outside Provider or Facility
A signed and completed authorization form is required, and no fees will be charged to process requests. Up to 15 calendar days will be required to process requests.

Payment Plans

Trophy Club Pediatrics policy is that any charges such as co-pays, deductibles, or non-covered services are due at the time of service. However, we do offer a limited payment plan for those patients who need some flexibility, with the following criteria:
You will be required to provide us with a credit or debit card number to automatically process your payment on specified dates. This can be done by completing the Payment Plan Consent Form.
The balance must be paid in full within six months of the date of service (unless otherwise specified), or six months from the date that we received payment from your insurance company (if applicable). Regular statements will not be mailed for this balance.
If at any point you are unable to keep this payment agreement, and fail to notify Trophy Club Pediatrics, your account will be sent to a collection agency.

 Call 817-400-1571 for more information

• Aetna
• Aetna Better Health (Medicaid)
• Ambetter - Superior
• Amerigroup Medicaid
• Ameriplan
• Blue Cross Blue Shield
• Cigna
• Galaxy Health Network
• Multiplan
• ​PHCS
• Scott & White Health Plan
• Superior Medicaid
• United Health Care
• Traditional Medicaid - Texas
• Wellpoint Texas
• Cook Children's Health Plan (CHIP & STAR)
• We also offer self pay and payment plans