Our Policies

Notice of Privacy Practices

North Shore Pediatrics, PC participates with most insurance plans and we are always adding new plans that we accept.  With the on-going name changes and mergers of insurance companies, it is more important than ever to make sure we accept your insurance.  While we are always happy to answer any questions, we have listed below all of the insurance carriers we currently accept.   It is your responsibility to insure that you have active health insurance and that one of our pediatricians is listed as your Primary Care Physician (for those plans that require you to have a PCP).

NSP Insurance Carrier List

Insurance is a contract between you and your insurance company. We are not a party to this contract. We file insurance claims on behalf of our patients. We will not become involved in disputes between you and your insurance company regarding deductibles, co-payments, covered charges, secondary insurance, “usual and customary” charges, etc. other than to supply factual information as necessary. You are responsible for the timely payment of your portion of your account with North Shore Pediatrics, PC.

Certain services and procedures provided by North Shore Pediatrics, PC (such as wart treatment, for example) may be your responsibility through your deductible. There is no way for North Shore Pediatrics, PC to know what services and procedures your particular policy covers until we file the claim and receive a response from your insurance company.It is your responsibility to know what services and procedures are covered under your policy and which services and procedure may be applied to your deductible. Any questions on whether a particular service or procedure will be covered or applied to your deductible should be directed to your insurance carrier prior to your visit in our office. We are unable to answer these questions for you.

It is your responsibility to provide timely and correct insurance information and to verify that all information contained in the “Patient Profile Form” is accurate. Most insurance policies have a timely filing period of 60 or 90 days after which claims cannot be submitted for payment. You must insure that you have provided our office with the correct insurance information at the time of service. Any claims denied due to incorrectly provided insurance information will be your responsibility.

A fee of $20.00 will be charged to your account for any/all/each returned checks. All future payments must be made by way of cash or credit card. Outstanding Balances – All past due balances are expected to be paid in full prior to any future appointments unless you have a previously established payment plan. North Shore Pediatrics, PC will not get involved in disputes between separated or divorced parents on responsibility for payment on an outstanding balance. North Shore Pediatrics, PC expects all account to be kept in good standing and reserves the right to refuse service due to outstanding balances on account.

We require 24-hour notice for any appointment cancellations. A fee of $25.00 will be charged to your account for any appointments that are not cancelled within a 24 hour period. Repeated cancellations or no shows for appointments could result in discharge from the practice.

North Shore Pediatrics, PC mails patient account statements monthly. If you believe that there is an error on your account or if you believe that another insurance company should be responsible for payment, it is your responsibility to notify us as soon as possible. North Shore Pediatrics, PC will not be able to assist you once the “timely filing” period of your insurance company has expired.

Appointments for physicals and non-emergency care can be booked as much as 6 months in advance. To book an appointment of this type, please call our office in Danvers at 978-406-4234.

Appointments for sick visits and emergencies can be booked on the day of service. Our telephone lines are open at 8:00 AM and the staff will be happy to arrange an appointment for your child to be seen as soon as possible. It is our goal to see all sick children on a same day basis. Our offices are also open for sick and emergency visits from 8:00 AM until 12:00 PM on Saturday and Sunday. There may be an extra charge to your insurance/account for appointments on Saturday, Sunday or Holidays.

Calls for appointments and sick visits after hours will be referred to our answering service and a triage nurse. In emergency situations after hours, please utilize the 911 system or report to your nearest Emergency Room.

We request that you provide our office with 24 hours notice if you need to cancel an appointment. Appointments that are not cancelled 24 hours in advance and “No-Shows,” may result in you being billed a fee for the visit.

In order to expedite your care, NSP has set up a referral line and coordinator to assist you. You can reach our referral line at 978-777-3908.

Because we understand that you may have questions that do not need a visit, NSP has a nurse triage system where you can get advice from one of our experienced nurses. If you would like to speak to a triage nurse, please contact our office. Our nurses will let you know if they determine an appointment should be made with one of our providers.

Medical offices and hospitals are two of only a very few business that provider services to customers without requiring payment at the time of service. For example, you cannot go to the grocery store, dry cleaners or a restaurant and leave without paying for your purchases or the service you received. In our business, we must rely on accurate health insurance information from parents to bill insurance carriers and often that is not enough to get a claim paid. We work very hard to make sure that each claim that should be paid by an insurance carrier is paid by that carrier. However, there are times when claims are not paid by insurance, such as when a deductible is involved, or it is a non-covered service. In those cases, the parents become responsible for the bill for services and should receive an Explanation of Benefits from their insurance carrier informing them about the insurance company’s decision.

Our office sends our monthly statements to each patient with a balance on their account. We greatly appreciate your timely attention to those statements. If a balance goes unpaid for more than 90 days, the account goes into collections. For us, this means that we will not provide prescriptions or routine care until the balance is paid. While this rarely happens, and we are happy to work out payment plans when needed, there are times when we are forced to take this action since, unlike a grocery store or dry cleaners; we cannot take back the services we provided.

If you have any questions about our patient accounts policies, please contact Kristen or David.

In order to provide the best care to our patient population, North Shore Pediatrics, PC
provides 24/7 support to patients and their families through telephone triage.
During normal business hours, our telephone triage is staffed by our in-office nurses and you
should receive a return call from one of our nurses within an hour of contacting us. In
times of extreme call volume, it may take longer than an hour to return a call. There is never
any charge for calling our office and speaking to a triage nurse.
After normal business hours, our telephone triage is handled by Night Nurse Pediatric
Triage. In order to speak with the after-hours triage, please call our office number and
you will automatically be routed through the answering service which will forward your message
to the triage service. You should receive a return call within one hour, except in times of extreme
call volume. The triage service is backed up by the North Shore Pediatrics physician that
is on-call for the evening. There is never any charge for calling and speaking to the
after-hours triage service.
There will be times when you want to speak to a physician or nurse practitioner. In those
cases, you should call our office and leave a message for the physician or nurse
practitioner you wish to speak to and you will receive a call back within 72 hours except
in times of extreme call volume. North Shore Pediatrics does bill your insurance carrier
for calls with physicians or nurse practitioners and it is possible that your insurance
carrier may transfer responsibility for payment to you under your copayment, deductible
or coinsurance. Calls after-hours with the on-call physician may also result in a bill being
submitted to your insurance carrier. For the most accurate information regarding your
responsibility under your insurance plan, please consult your Summary of Benefits or
contact your insurance carrier at the telephone number located on your insurance card.
As always, if your matter is a medical emergency,
please dial 911.

North Shore Pediatrics, PC will remain neutral in all divorce/separation disputes. Our primary responsibility is to provide quality pediatric care to our patients. We assume that children are in the joint custody of their parents and that both parents have rights to view their child’s medical records and make medical decisions, unless we have been provided with court documents that clearly stipulate otherwise. The parent accompanying a child to a visit will be assumed to have medical decision-making rights. We will not be responsible for informing the non-accompanying parents of the details of the visit. Parents are expected to work out a system of communication that does not require us to act as mediator. All of our communications will be with parents; we will not have any communication with lawyers involved in custody disputes, unless required to do so by court order.

We are contractually obligated to collect a copay at the time of service. Whomever accompanies the child to the office is expected to pay the copay at the time of the visit. Occasionally a child’s health insurance is provided by a non-custodial parent. Because our provider-patient relationship exists with the care-taking parent in these circumstances, the ultimate responsibility for payment rests with the adult who accompanies the child to the office.

We reserve the right to ask families to leave our practice if a custody disputes interferes with our ability to care for a child or conduct our daily business.

As a recipient of Federal assistance, including Mass Health, North Shore Pediatrics, PC does not exclude, deny benefits to, or otherwise discriminate against any person on the grounds of race, color, national origin, disability, age, sex, sexual orientation, gender identity, religion or creed in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, and in staff and employee assignments to patients, whether carried out by North Shore Pediatrics, PC directly or through a contractor or any other entity with which North Shore Pediatrics, PC arranges to carry out its programs and activities. 

This statement is in accordance with the provisions of Title VI of the Civil Rights Act of 1964 (nondiscrimination on the basis of race, color, national origin), Section 504 of the Rehabilitation Act of 1973 (nondiscrimination on the basis of disability), the Age Discrimination Act of 1975 (nondiscrimination on the basis of age), regulations of the U.S. Department of Health and Human Services issued pursuant to these three statues at Title 45 Code of Federal Regulations Parts 80, 84, and 91. 

Additionally, in accordance with Section 1557 of the Patient Protection and Affordable Care Act of 2010, 42 U.S.C 18116, North Shore Pediatrics, PC does not exclude, deny benefits to, or otherwise discriminate against any person on the ground of sex (including gender identity) in admission to, participation in, or receipt of the services and benefits under any of its health programs and activities, and in staff and employee assignments, whether carried out by North Shore Pediatrics, PC directly or through a contractor or any other entity with which North Shore Pediatrics, PC arranges to carry out its programs and activities. 

In case of questions, please contact: 

North Shore Pediatrics, PC 480 Maple Street, Suite 3A Danvers, MA 01923 

Contact Person/Section 504 Coordinator: David L. Smith 

Telephone: 978–406–4234 

Whenever possible, North Shore Pediatrics, PC attempts to resolve patient questions or concerns quickly and informally. If this is not possible, patients are afforded the opportunity to file a formal grievance. Because physicians and staff members are usually the first point of contact for patients, all North Shore Pediatrics, PC employees have an understanding of the organization’s grievance procedures. 

The following is the formal method used to see answers or resolutions of grievances. All grievances are reviewed by the Practice Administrator, Nurse Manager, Billing Manager and/or the North Shore Pediatrics, PC physician Partners. 

All grievances should be addressed to the Practice Administrator at: 

North Shore Pediatrics, PC 480 Maple Street, Suite 3A Danvers, MA 01923 Attention: David L. Smith 

All grievances will be reviewed and investigated by the management members most familiar with the area of complaint. For example, a complaint regarding quality of care would be reviewed by the Practice Administrator, Nurse Manager and a physician Partner. A complaint regarding billing information would be reviewed by the Practice Manager, Billing Manager and a physician Partner. Regardless of the area of complaint, the responsible Managers will investigate and provide a written notice of the practice’s decision within 14 days of the complaint. 

If a patient is not satisfied with the response of the response provided by the investigating Manager’s, the patient may request a review of the complaint and response by the Physician Partners of North Shore Pediatrics, PC. That request should be addressed to: 

Thomas M. Seman, MD North Shore Pediatrics, PC 480 Maple Street, Suite 3A Danvers, MA 01923 

The Physician Partners will investigate and provide a written notice of the practice’s decision within 14 days of the escalated complaint. 

In order to fully investigate any complaints, please provide the essential facts of the complaint. What health plan services were not received? What was wrong with the service received? What billing issues are there? Explain who, what, when, where and how. Please attached any documentation that you feel is in support of the complaint. 

Below is the Standard Fee Schedule for North Shore Pediatrics, PC.   Because our entire fee schedule is over 280 pages with close to 20,000 procedure codes, many of which will never be performed in our office, we have listed below the most common procedures performed in our office.  Should you wish to see the entire list, or have a question about a specific code not on the below list, please feel free to ask us and we will be more than happy to provide you with that information.  We are also happy to provide you with a good faith estimate of the cost of your visit prior to your appointment.  Please feel free to contact us at 978-406-4234 and ask for Billing.

North Shore Pediatrics Standard Fee Schedule

Warts are a common complaint in the pediatric population. Most children will likely have at least one wart before they turn 18. There are several types of warts that we encounter in the office. Most people are familiar with the plantar wart, which occurs on the bottom of the foot, but warts can occur on any part of the body. There are also flat warts, known as molluscum contagiosum, which are smaller warts that often come in clusters. Lastly, there are also genital warts, which are less common.

Warts can be painful, itchy and unsightly. Many people seek treatment for warts in the office for the aforementioned reasons, as well as the fact that they can spread and are contagious. Warts are viral, thus there is no oral medication that has been guaranteed to eradicate them. We treat warts frequently in the office. Outlined below are the most frequent methods used.

There are always possible side effects when treating a wart. With the first two options, we expect a blister, but sometimes the blister is larger and more painful than anticipated. Untreated warts can cause scarring, but treatment may also cause scarring. There is also the risk of warts spreading or lack of resolution with appropriate
treatment.

Treating a wart is considered a “surgical procedure” when billed to insurance and in many instances your insurance will transfer responsibility for payment to you under your deductible or co-insurance. Warts take time and money to treat. The medications that we use are expensive. We bill the same way that the dermatologist or the podiatrist bills. As there are thousands of different insurance plans, our office has no advance knowledge of what is covered by your insurance when we bill for this procedure. If you are considering wart treatment, please consult your insurance plan beforehand, as we can not be responsible for procedures that are not covered by your insurance. Your insurance plan will be the best place to consult, as our office will not be able to supply you with accurate answers to coverage questions. On average, you can expect wart treatment to result in a bill of approximately $350.00 You will be asked to sign a waiver in the office stating you understand that insurance may not cover the wart treatment. You can download and sign this waiver ahead of time here.

Lastly, we are always happy to discuss over the counter options for wart treatment. As we treat warts in the office, unless otherwise directed by your physician or nurse practitioner, we do not refer to dermatology or podiatry for wart treatment.

Thank you in advance for your understanding.

There are waivers due to different insurance plans for the following, all of which may be downloaded, printed and signed prior to your appointment. Feel free to check with your insurance coverage before coming:

Wart Waiver

Meningitis B immunization

Hepatitis A immunization if over age 19

Once our patients turn 18 years of age they are asked to read and sign a waiver form about their medical record. The patient can choose (or not) to give permission for each of the following:

• Allow a parent or caregiver to schedule or cancel appointments
• Allow a parent to speak to a triage nurse
• Give a parent access to ALL medical records including lab results, notes, discussions with their care providers
• Deny all access to medical records

Click here to view and print a copy of this waiver before your appointment.