Your Visit > Office Policies

Office Policies

Financial Policy

Upon Registration We will need the following information and items: Insurance Card (if you’re a member of one of the plans we accept); the name, date of birth, employer and address of the plan member; the patient’s address, date of birth, and  contact phone numbers for both parents and/or all guardians.

Health Insurance Cards

When scheduling each appointment, our team will verify your insurance information. Our office staff will verify your eligibility prior to or at check-in for each appointment. If your insurance information changes, please notify us as soon as possible. Please make sure you bring your card to every appointment.

Health Insurance Plans

Because we participate with many different plans, we can’t know the provisions of each patient’s policy. We do recommend that you make every effort to understand your insurance coverage and, if necessary, to contact your carrier before receiving services, so you can verify your coverage levels (such as those for preventive care), co-pay, deductible, and co-insurance responsibilities.


We’re contractually obliged to collect, and you’re responsible to pay, your co-payment at the time of your visit. Please have your co-payment ready at check-in. If you don’t pay your co-payment at the time of service, we’ll need to add a fee (currently $5) for the cost of billing you.

Balances & Deductibles

We’re responsible, as detailed by the terms of our contracts with health insurance companies, for billing you for any portion of your treatment that your health insurance carrier does not pay and assigns as your responsibility. You are responsible for paying this portion of your bill

Self-Pay Patients

If you don’t have health insurance, we’re out-of-network for your particular insurer, or you’re receiving a non-covered service, payment at the time of the visit is required.. We’re also happy to work with families to create a payment plan for any non-covered services. Just ask us!

For a downloadable copy of the PAK Financial Policy, click here.

Missed Appointments

Life happens, so we understand that sometimes you can’t make your appointment. Please call us at least one full business day in advance to cancel or change an appointment. If you don’t call to cancel in advance, we reserve the right to charge a Failed to Keep Appointment fee (currently $25) to cover the cost of the unfilled appointment slot. Multiple missed appointments, or failure to comply with other PAK  policies, may result in dismissal from the practice.

Late Fees / Collections

If you don’t make full payment (or call to set up a payment plan) within a reasonable time period, you will be charged a $5 billing fee each billing cycle to cover the cost of sending you a bill.If your account maintains an open balance, it may be sent to collections and subject to an additional 25% collection fee. If you’re having difficulty meeting medical bills, please let us know. We’ll be happy to help you by setting up a payment plan.We encourage our patients to take advantage of this option, as we may have to dismiss from our practice patients who fail to meet their financial obligations.

Returned Checks

If you pay by check and your check is returned for insufficient funds (NSF), you’ll be responsible for the amount of the check, plus a returned check fee of $25. If more than one check is returned in any given period, we reserve the right to require all future payment by cash or credit card to prevent those situations from recurring.


The cost of researching, filling out, and signing forms is not covered by health insurance programs. We charge a nominal fee to cover the costs of completing these forms. The fees are posted in the check-in area and may change from time-to-time.


The parent or guardian who signs the patient’s paperwork is the party responsible for all charges and payments. Due to confidentiality laws, we can only bill the person who signs the practice paperwork. Therefore, if the person responsible for the medical bill changes, the new guarantor must fill out a new set of paperwork. If your payment circumstances change, please inform us right away. We do have packets for patients 18 years or older that must be completed. These forms explain to the patient their responosility with their account now that they are a young adult.

Newborn Insurance Reminder

Congratulations on the wonderful new addition to your family!

New parents don’t always know, or they may forget during the busy, crazy, wonderful days that follow the birth of a child, that babies are not automatically covered on all insurance plans. So here’s some important information you’ll need to remember:

Not all insurance policies offer automatic coverage for new babies. However, some plans do offer 30- or 31-day coverage until you can physically add the baby to your plan.

Making Sure Your Baby is Covered

We recommend that you check with your HR department or member services to see how your individual health plan works, and to begin the process of adding your baby to the insurance.

If the newborn coverage period has ended, and the newborn is not showing active on an insurance policy, the baby’s parents will be responsible to pay out of pocket for the visit. This may also lead to a lapse in coverage for your child.

If your child has been added to an HMO, CHIP, or Medical Assistance plan, it’s imperative that you have PAK listed as the PCP.

If you have any questions or concerns, just give us a call at:
570-288-6543 option 6


The PAK Team

Affordable Care Act Information

No matter how you feel about the Affordable Care Act, the overall goal of the program is to provide access to affordable, high-quality health care — and that’s a goal we strive for at PAK every single day.

What do parents need to know, and how can you make this work for your family? That can get a little complicated, depending on your situation. But to start, you need to know…

A Few Basic Details

 You must have health insurance, or face tax penalties.

 If you already have insurance through your employer, that can stay the same, or your employer may choose to have employees use the online insurance marketplaces.

 If you don’t already have insurance, you can shop for coverage on the new online insurance marketplaces (also called insurance exchanges) for each state. Plans are surprisingly affordable compared to what we’re used to, and there are subsidies available to help low- and moderate-income families.

•  You can no longer be denied coverage for pre-existing conditions, nor can insurers cancel your coverage if you get sick.

  PAK is a proudly independent, physician-owned practice. We accept most  insurance plans, so your ability to see us should  NOT be affected by the new marketplaces.

Important Items for Children & Young Adults

 All plans must include coverage for basic well-child care, including immunizations, vision, and dental care.

 Young adults can remain on their parents’ health insurance until they turn 26 years old.

 Young adults who aged out of foster care at 18 years or older are eligible to receive coverage through Medicaid until they turn 26 years old. People adopted from foster care may qualify for Medicaid coverage until age 26, depending upon income.

Other Resources

The American Academy of Pediatrics has developed some great resources to explain this information in more detail, and to help you to access Pennsylvania’s online registry. Check them out here…

AAP Pamphlet: The Affordable Care Act and You

AAP Healthy Children Resource Page: What Your Family Needs to Know (w/ Links)

As always, if you have any questions or concerns, just give us a call in the office. We’re always happy to help in any way we can!


Back To School

School Vaccination Information For Parents
School Vaccination Requirements

Welcome Packet

Welcome Packet Part 1 (Read Only)
Welcome Packet Part 2 (Print & Return)


ADHD Vanderbilts Parent and Teacher
ADHD Adult Forms

Health Forms

State of Pennsylvania Child Medical Examination
PIAA Sports Physical Form 2019 (Section 5 Health History must be completed by parent for the physician to review)
Non Commercial Drivers License Application


Download and complete prior to appointment
Peak Flow Meter Instructions
Asthma Assessment 5 yrs and older
Asthma Control Test
Asthma Follow Up 12 yrs and older
GERD Education

New Patient

Financial Policy
Privacy Policy
Medical Records Request to PAK


Informational packet to explain young adults responsibility with his/her account.
Medical Records Release from PAK
Authorizes selected individuals to accompany, provide consent for treatment, and or receive protected health information about the pediatric patient.
Patient Portal Enrollment Form

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451 3rd Avenue, SUITE 1 | Kingston, PA 18704 | Phone: 570-288-6543
1081 Oak Street | Suite 1 | Pittston, PA 18640 | Phone: 570-602-PAKP
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