Policies & Forms
Policies & Forms
Learn about the policies that help us provide you with the very best of care.
Billing & Insurance Policies
We are committed to providing you and your children with the highest caliber of care. As part of your relationship with Piedmont Pediatrics, a clear understanding of our financial policies is important so you will know what actions Piedmont Pediatrics will be undertaking on your behalf as well as what your financial responsibilities are to Piedmont Pediatrics.
Read our Complete Financial Policy »Excluded Insurance Plans
- We participate in most insurance plans, with the exception of the providers listed below. This list is subject to change without notice.
- Aetna Select HMO
- Aetna Whole Health
- Ambetter
- Amerigroup
- Caresource
- Kaiser HMO plansWe do accept Kaiser through PHCS.
- OscarWe do accept Cigna with Oscar.
- Medicaid/Medicare
- Peachstate/Peachcare
- Wellcare
Insurance Benefits
You must know your insurance benefits. Your insurance policy is a contract between you and your insurance company even if your employer provides the policy. You are responsible to know the coverage and know how much of the cost is your responsibility. You will be responsible for any part of the visit cost that your insurance does not cover including deductibles and co-payments.
Insurance Card
You must show your current insurance card at every visit. We will attempt to validate your insurance benefits at the time of service and alert you to any problems.
Co-Payments
You must pay your co-payment at the time of the office visit. Our contracts with insurance companies require us to collect your co-payment at the time of service.
Secure & Convenient Online Payments
Piedmont Pediatrics works with industry-leader Payment Pros to enable our patients to safely and securely pay their bill online through our website or through your patient portal.
Autopay
To streamline our billing and payment system and to provide a seamless, convenient way for patients to pay their bills, Piedmont Pediatrics now offers AutoPay and requires all patients to keep an active credit card on file with us.
Financial & Privacy Policies
- Please review these important policies.
- Financial Policy
- Credit Card on File (Autopay)
- Annual Administrative Fee (AAF)
- Advance Beneficiary Notice of Noncovered Services
- Notice of Privacy Practices
Patient Forms & Downloads
For your convenience, we have provided various forms below that you may download, complete your portion, and upload into the portal for physician review. Please do not submit blank forms for physician review or your request will be denied and returned.
New Patient Forms
- Please complete this form in preparation for your first visit.
- New Patient Registration
Financial & Privacy Policies
- Please review these important policies.
- Financial Policy
- Credit Card on File (Autopay)
- Annual Administrative Fee (AAF)
- Advance Beneficiary Notice of Noncovered Services
- Notice of Privacy Practices
GHSA Physical/Sports Forms
Form Requests
Our children are going off to camp! How do we get our forms to our physician?
Form requests are processed through our patient portal, My Kids Chart. You are able to upload a picture or PDF of the form that you need, and we will deliver the completed form for convenient retrieval.
Login to the patient portal, then click Create Message and choose the subject Forms Request.
- Form requests must be submitted via the patient portal or in-person.
- If you have an upcoming wellness exam, please bring your forms to the appointment so that your physician may complete them the same-day.
- Any physical examination forms (including but not limited to GHSA sports packets, Georgia form #3300, school examination forms, etc.) cannot be processed if the patient has not had a wellness exam within the last 12 months from the date of form submission.
- Patients over the age of 18 years will need to submit their own requests or submit a parental authorization form to further allow parental access to medical records on behalf of the patient, including access to the patient’s chart in the patient portal. Without prior parental authorization, access to these patient’s records will be denied.
- Form request turnaround time is seven to ten business days from the date of submission. We make every effort to complete forms as quickly as possible, but the heavy volume of requests may cause delays– so plan ahead.
- Parents must complete all information on the forms that they have knowledge of (such as patient demographics & signatures , health history, allergies, medications etc.) Blank forms will not be accepted for physician review, and forms missing any of these fields may cause delay in the request.
Appointment Policies
An appointment is required for your child to be seen. If you are going to be late for an appointment or need to cancel, please call our office.
There are typically 4 to 5 doctors in the office on weekdays. Every attempt will be made for you to see the doctor of your choice. Saturday office hours are shared by the physicians in the group on a rotating basis.
Missed Appointments
We require at least a 24-hour notice for any cancellations or rescheduling of a previously scheduled appointment.
Missed appointments and late cancelations represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. Failure to cancel or reschedule your appointment 24 hours in advance will result in a $50 administrative fee per appointment. These fees are not covered by your insurance company and are the sole responsibility of the guarantor on the account.
Saturday Office Hours
Piedmont Pediatrics operates on Saturdays for urgent care/sick children only. Piedmont Pediatrics charges an additional fee for Saturday services. This fee may or may not be covered by your insurance carrier.
Vaccine Appointments
You can schedule your Flu or COVID vaccine appointment using our patient portal.
After-Hours Care
If your child’s illness or injury is life threatening, call 911.
After-Hours Nurse Line
For urgent medical issues that cannot wait until business hours, call our office at (404) 351-6662. We partner with the Children’s Healthcare of Atlanta after-hours nurse line to ensure someone is always available to answer your questions.
One of our physicians is always on call for further questions or emergencies and to provide important continuity of care for you and your family. Please make sure you have your pharmacy’s name and phone number available.
After hours calls should deal only with illness or injury requiring immediate attention. Other calls involving routine issues, and prescription refills should be dealt with during normal business hours only.
Urgent Care
For patients whose problem is serious enough to be seen outside of routine hours, we encourage you to use Children’s Healthcare of Atlanta at Scottish Rite, Egleston, or Hugh Spalding.
Prescription Refills
Our patient portal makes prescription refill requests easy and efficient.
Refill Instructions
Prescription refill requests are processed through our patient portal, My Kids Chart. Please login to the patient portal, then click Create Message and choose the subject Refill Request.
It is very important that you include:
- The name of the medication
- The strength, dose, and the frequency with which it is taken
- Pharmacy name and phone number
- For asthma medicine, please specify the delivery method (such as nebulizer, metered dose inhaler, etc.)
Failure to provide this information may cause a delay in filling the prescription.
ADHD Medications
ADD/ADHD medications are classified as schedule II controlled substances. These medications are federally controlled by the DEA and the FDA, which means a written prescription is required for each refill. Refills cannot be called or faxed to a pharmacy. Likewise, the pharmacy cannot call your doctor to get approval for your ADD/ADHD medication refills.
As recommended by the American Academy of Pediatrics, in addition to a yearly physical exam, your child will need to have a medication check with one of our doctors or nurse practitioners every THREE MONTHS. The six-month follow-up visit will need to take place in our office so that we can obtain vital signs, but the three-month and nine-month med-recheck visit may be a virtual telemedicine visit if desired.
This visit schedule must be followed for your child to continue to receive medication refills, as it is important to make sure that your doctor is carefully monitoring the efficacy and side effects of these medications.
Anxiety/Depression Medications
In addition to a yearly physical exam, if your child is taking a medication for anxiety or depression, they will need to have a medication check with one of our doctors or nurse practitioners every SIX MONTHS. The six-month follow-up visit will need to take place in our office so that we can obtain vital signs.
This visit schedule must be followed for your child to continue to receive medication refills, as it is important to make sure that your doctor is carefully monitoring the efficacy and side effects of these medications.
Piedmont Pediatrics
105 Collier Road NW
Suite 4060
Atlanta, GA 30309
Phone
(404) 351-6662
Main Fax
(404) 351-6030
Medical Records Fax
(404) 793-0477
Billing Phone
(404) 351-7828
Billing Fax
(404) 793-0478
Parking
We are located directly behind Piedmont Hospital. Parking is available in the north and south parking decks. The “B” level of the north parking deck provides a covered walkway into our building. We are on the 4th floor in Suite 4060. Valet parking is also available.
Office Hours
Monday - Friday
8:00 am - 5:00 pm
An appointment is required.
Saturday
9:00 am - 12:00 pm
Urgent care illnesses only. We see patients on a first come first served basis, no appointment required.
If you are going to be late for an appointment or need to cancel, please call our office.
There are typically 4 to 5 doctors in the office on weekdays. Every attempt will be made for you to see the doctor of your choice. Saturday office hours are shared by the physicians in the group on a rotating basis.
After-Hours Care
If your child’s illness or injury is life threatening, call 911.
Otherwise, for urgent medical issues that cannot wait until business hours, call our office at (404) 351-6662. We partner with the CHOA after-hours nurse line to ensure someone is always available to answer your questions. One of our physicians is always on call for further questions or emergencies and to provide important continuity of care for you and your family.
Poison Control Hotline
(800) 222-1222
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