Office Policies/Fees

Please read the detailed financial policy and practice policies below. These policies are in place to allow us at Callisto Pediatrics to provide the best medical care for your child.


All insurance recipients must present their current insurance card at the time of service. If you do not have your insurance card you will be considered a self-pay patient and the guarantor is responsible for payment for any service not covered by your insurance. We recommend that you make every effort to understand your insurance coverage prior to receiving services so that you can verify your coverage level and co-insurance responsibilities. We are happy to work with families that prefer to pay directly for services or do not have insurance. For Billing inquiries, families can submit them online on our Billing Inquiry Form. This allows for a written record of all inquiries and track response times:


The co-payment is a contract agreement required by the insurance company. Therefore, we are obligated to collect and you are responsible to pay your co-payment at the time of your visit. Please have your copayment ready at check-in. If you don’t pay your co-payment at the time of service, you may incur a fee for the cost of billing you. Please note that depending on your insurance policy, if you have not paid your deductible in full it is likely that any non-preventive service will require payment at the time of service. 

We provide a variety of payment options. For your convenience, we accept all major credit cards, cash, checks, and Health Savings Account (HSA) cards for payment. Returned checks will be subject to a $25.00 returned check fee. 

Credit Card on File Policy

Callisto Pediatrics is committed to making our billing process as easy as possible, so we require that all patients provide a credit card, debit card, or HSA card to be on file with our office or maintain a $50.00 balance, per child, with the office. Credit cards on file are stored in a secure, compliant location in your electronic medical record with only the last four digits visible to staff. Credit cards or balances can be used to pay copayments or non-covered charges at the time of the visit. If we do not receive payment for the amount listed on your statement within 15 days, we will run the credit card for the full amount owed. If your payment is declined, a $25.00 declined payment fee will be applied. Please keep in mind, the credit card payment for any patient balance will be charged after the insurance has paid their portion. 

Payment Late Fees/Collections

If you do not make full payment (or call to set up a payment plan) within 30 days after billing, then the unpaid balance will be subject to a monthly late fee of $25.00. If your account maintains an open balance, it may be sent to collections and be subject to additional collection fees or legal action to obtain payment. If you’re having difficulty meeting medical bills, please let us know. We are happy to set up a payment plan and assist families, if possible, but patients who fail to meet payment obligations may have to be dismissed from our practice. 

Appointment Cancellations and Late Arrivals

We understand that sometimes things come up unexpectedly, so we understand that sometimes you may be late or are unable to make your appointment. We respect our patient’s time and we request the same courtesy from our patients. Patients arriving more than 10 minutes past their appointment time may be offered a later appointment for the same day if available. Patients arriving more than 20 minutes past their appointment time are considered a “no show.” We ask that you contact us at least one (1) business day in advance to cancel or change an appointment. If you don’t call to cancel in advance or if you are considered a “no show” to the appointment, we reserve the right to charge a $25.00 fee. After three (3) no-shows or same day cancellations your family may be dismissed from the practice. 


We are happy to complete two forms free of charge during your annual well visit which can be processed at the time of your appointment. Additional forms or forms brought at other times will be completed within 3-5 days for a $5.00 service fee. Forms can be rush completed in 24 hours for a $10.00 service fee. 

Vaccination Policy

Callisto Pediatrics firmly believe in the importance of vaccinations and the part they play in preventing serious and life-threatening illnesses. We respect your decision as parents regarding the vaccination of your children. Therefore, if you opt to delay or decline vaccinations recommended per CDC guidelines, you will be obligated to sign the American Academy of Pediatrics (AAP) Refusal to Vaccinate Form at every well visit. Altering or refusing to sign the AAP Refusal to Vaccinate form will result in dismissal from our practice. We will be happy to continue to care for your children regardless of their vaccine status as long as they remain current with their regular well child checks as these check-ups are necessary to monitor growth and development. 

Telehealth Policy

Callisto Pediatrics provides telehealth appointments as a limited alternative to in-person sick patient appointments, where you can conveniently have a video conference with your health care provider. In choosing to participate in a telehealth appointment, some parts of the exam will be limited. If the telehealth appointment is not adequate for the situation the health care provider can discontinue the telehealth appointment at any time and recommend alternatives to telehealth including an in-person appointment or emergency medical services if necessary. 

Split Family Policy

Callisto Pediatrics does not get involved in disputes between divorced, separated or custodial parenting arrangements regarding financial responsibility for their child's medical expenses. We will collect co-payments and deductibles from the attending parent and will hold the attending parent responsible for any other payments associated with that visit. The guarantor will be financially responsible for the care we provide to your child, regardless of whether a divorce decree, custodial, or other arrangements place that obligation on your former spouse or the child’s other parent. We will be happy to provide receipts for paid medical bills for you as requested. Please note, that we will not call the other parent for consent prior to treatment or to inform the non-present parent of the assessment and/or plan of care. We expect the parents to communicate any treatment plan with each other. Unless a court order requires us to do so, we will also not restrict either parent from access to their child’s medical information.

Inappropriate Behavior

Callisto Pediatrics strictly prohibits verbal abuse, physical abuse, or threats of any kind to our physicians, nursing staff or office staff. If you are witnessed displaying these types of behavior in our office you will be dismissed from our practice. For the health of our patients and staff, no smoking or vaping is allowed in the office at any time.  

Non-Discrimination Policy

Individuals at Callisto Pediatrics will not be discriminated against because of race, color, creed, religion, sex, age, sexual preference, national origin, citizenship, marital status, disability, veteran status, or any other status or characteristic protected under federal, state, or local laws.  Acts of discrimination and/or harassment based on any of those factors and will not be tolerated as this is inconsistent with our philosophy and our core principles.

You can review the Callisto Pediatrics Privacy Policy here

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open until 7:00pm every 3rd Wednesday


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