North Alabama Children's Specialists

MAKE A PAYMENT TO NORTH ALABAMA CHILDREN'S SPECIALISTS

Statement of Financial Policy

Our primary interest at NACS in in taking care of your child. However, we must enforce our financial policy in order to continue to provide your child with the best care possible. By signing as responsible party you are acknowledging the following statement.

I have read the Statement of Financial Policy. I understand and agree to the policy.

Methods of Payment
We accept cash, personal check, and credit/debit cards (MasterCard, Visa, American Express, and Discover).

Demographic Updates/Responsible Party
Please notify our front office staff if there are any changes to your insurance policy, address, and/or phone number. In order to maintain current records we require that the responsible party complete and sign a demographic form annually. The person who brings the child for treatment and signs the paperwork is the responsible party. In circumstances where parents are separated or divorced, NACS will not act as a mediator in collecting payment.

Insurance
We will accept and file claims with any insurance carrier with whom we are a participating provider. As a courtesy to our patients we will also file claims with non-participating carriers. Filing a claim does not guarantee payment. It is the responsibility of the cardholder to know what their eligibility and coverage is. If this is not known it is the cardholder's responsibility to verify coverage limitations prior to the appointment date.

Payment Arrangements/Past Due Accounts
Please call our Business Office if you have questions regarding your account balance. Payment arrangements can be arranged if needed. Statements are mailed monthly. If your account balance becomes past due, appropriate action will be taken to collect the amount due. Accounts that are overdue more than 90 days will be turned over to a collection agency. At that point, you will be responsible to pay the account directly to the collection agency and any fees due to them.

Referrals
It is your responsibility to ensure that all necessary referrals from the correct assigned Primary Medical Provider are in place. Some insurance companies including Medicaid will not pay specialized services without a referral. Any payment denied for lack of referral will be forwarded to the responsible party for payment.

Financial Assistance

You may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For Children’s Financial Assistance Policy contact 1-844-750-8950 or contact the Business Office at 205-638-2722. You can also visit www.childrensal.org/financial-assistance for additional information.

Non-Covered Services & Additional Charges

Processing Fee
Copays/Coinsurance, dedcutibles, and non-covered services are due in full and payable at the time service is rendered. A $10 processing fee will be charged to your account if payment is not made at the time of service.

Returned Checks
There is a $25 fee for all returned checks

No-Show Appointments
There is a $25 fee for all "no show" appointments. As a courtesy we provide an appointment reminder slip at check out and a call reminder four days before your appointment. We can also send email reminders of your appointment. Although our office provides these reminders for you; it is ultimately your responsibility to inform the office of cancellations/reschedules within 24 hours to avoid being considered a "no show." More than two "no-shows" annually may result in dismissal from the practice.

Medical Records
Please contact Medical Records for all requests.

Forms
A $5.00 form fee will be charged for all forms requested outside of an office visit. Allow 48 hours for your request to be processed. There is no charge for work/school excuses. Please remember to request these at check-out.

In order to protect the privacy of our patients we do not fax forms. Forms can be mailed to your home address if the form fee has been paid.

General Forms
Request Medical Records (Electronic Form)

Request Medical Records (PDF)- English

Request Medical Records (PDF)- Spanish

Pulmonary Forms
New Patient (Pulmonary)

Neurology Forms
New Patient (Neurology)

Nutrition Forms
Diet History
Food Record
Keeping A Food Record

Physician Forms
Outpatient Referral

Clinical Nutrition

Clinical nutrition services are provided on an outpatient basis. Outpatient appointments for medical nutrition therapy are scheduled upon receipt of a physician referral.

Nutrition services provided for children ages 0-19 years include:

• Nutrition assessment (which may include any or all of the following: obtaining and evaluating nutrition/feeding histories, evaluating growth, evaluating lab values, evaluating physical findings, assessing drug/nutrient interactions, recommending and implementing methods for and management of nutrition support therapies, evaluating educational needs of patient and caregiver, and evaluating compliance with prescribed nutrition regimen).
• Nutrition intake calculation and evaluation
• Nutrition education/counseling for normal nutrition, disease state management, drug/nutrient interactions, or altered feeding regimens
• Management of parenteral and/or enteral feedings and/or nutrient supplementation under medical direction
• Nutrition physical examination and assessment

Staff

Emily Eckley, MS, RD
emily.eckley@childrensal.org
 

Our clinical nutritionist is registered by the Commission of Dietetic Registration of the American Dietetic Association and is licensed to practice in the state of Alabama. Our Clinical Pediatric Dietitian has obtained the requirement of Master’s degree in nutrition and has clinical pediatric experience including certification of training in childhood and adolescent weight management.

Hours
Individual appointments are scheduled during normal business hours Monday-Friday by our nutritionist based on the needs of the patient in the best way possible. Morning appointments, as early as 8:00 a.m., and afternoon appointments, as late as 4:00 p.m., are available upon request.

Contact Information
Number for Referral: 256-533-0833, ext 6
Fax Number to Refer Patients: 205-638-2058

Please complete and fax Outpatient Referral Form for Physicians below.
Outpatient Referral Form

Electroencephalogram (EEG)

My Child is having an Routine Sleep Deprived EEG ?
An EEG records the brain's electrical activity. These recordings look for abnormalities that may occur in patients with seizure disorders. Important information can be obtained to aid in evaluation, diagnosis and treatment of the patient. The EEG is performed with electrodes that are attached to the scalp with special paste. A SLEEP DEPRIVED EEG is an EEG that requires the patient to be deprived of sleep. The EEG takes about 1 hour to complete. The child is not given any medications during the EEG.

My Child is having an Ambulatory EEG?
An ambulatory EEG helps to capture your brain's electrical activity for 72 hours. The electrodes are attached to the scalp with a special paste during the sleep deprived EEG. You are given a special recorder that is slightly larger then a portable cassette player with a strap to carry on your shoulder the wires run either under your shirt or outside of it. Then you go about your normal routine. We prefer for the child to go to school if he or she will so we can get a true daily activity log. Attach to the portable recorder you will have an "event" button that you press if you experience any of the symptoms that you are being tested for. You are also asked to keep a diary of your actions during the day to help the doctor identify the cause of abnormal activity if any is recorded.

Does my child need to be on a special diet prior to their EEG?
Your child may eat a regular diet EXCEPT for caffeine or chocolate the day before and the day of the test.

How does my child need to have his or her hair the day of the test?
Your child's hair must be clean, completely dry and brushed out. NO mousse, gels, oils, creams, hairsprays or braids.

What do we need to do if we need to cancel an EEG appointment or are running late to an appointment?
If your child has a 7:30 a.m. EEG appointment and you are going to be late or must cancel please call the office at 7:20am and ask for the "back line" to speak to the EEG Tech. We request if you can not make your scheduled EEG appointment you let us know 24 hours in advance since EEG appointments are very limited and there is a waiting list. Also anyone who is 30 minutes late for their EEG may have to be rescheduled for another date.

What days do you do EEG in the office?
We do sleep deprived EEG on Monday, Tuesdays and Fridays starting at 7:30 a.m. to 2:30 p.m., Thursdays 7:00 a.m. to 2:00 p.m.

Instructions for Sleep Deprivation:

• Infants: Once they wake in the morning keep them awake until their appointment
• Ages 1-4 years: Go to bed one hour later than normal the night before and wake them 2 hours earlier than normal and keep them awake until appointment
• Ages 5 & up: Must have NO MORE than 6 hours of sleep the night before test. Patient needs to wake 2-4 hours earlier than normal and keep them awake until appointment
• PLEASE DO NOT ALLOW PATIENT TO FALL ASLEEP ON THE DRIVE TO THE OFFICE OR WHILE IN THE WAITING ROOM
• They may eat a regular diet EXCLUDING chocolate and caffeine the day before test and the day of the test. Take all medicication EXCLUDING sleep aids as normal
• Hair must be clean, completely dry and brushed out-NO mousse, oils, gels, creams, hairspray or lotion on face or head. NO braids