Right From the Start Pediatrics  
     
     
Frequently Asked Questions
Frequently Asked Questions
DANIEL MORRA, MD
Physician and Office Administrator

JAN ENZWILER
Office Administrator

LINDA TAYLOR
Billing and Reception

KRISTIN ETLING
Front Desk / Reception

JAIME BECKER, RN
Registered nurse

KARIS MEYER, RN
Registered nurse

ELIZABETH SPIREK, RN
Registered nurse

PAT BRANDMEYER, RN
Registered nurse

STEPHEN WEIERSMUELLER
Information Technology Support

Office Policies


WELCOME TO RIGHT FROM THE START PEDIATRICS, SC!

Dr. Morra and his staff of Right from the Start (RFTS) Pediatrics would like to welcome you to our practice. We look forward to providing quality pediatric care to your children for many years to come. We would like you to review our office policies and welcome any questions you have about them.

At the time of your first visit, or shortly thereafter, Dr. Morra requests that you obtain all of your child's previous medical records for his review. Your child's vaccination record and growth chart are two of the more valuable pieces of your child's medical record, and if possible, you should obtain these (via fax to our office) if nothing else while your previous physician prepares your old records for transfer. If you have not already, you will need to sign consent for those records to be sent to us. We will have a similar consent for you to sign.

There are other forms that you will need to review and consents that you will need to sign at your first visit here. Please take the time now to review these, ask any questions you have about them, and sign them for inclusion in your child?s chart. These forms include the following:

* Notice of Privacy Practices (NOPP) according to the Health Insurance Portability and Accountability Act (HIPAA) of 1996

* General Consent or Refusal of Consent to Administration of Antibiotics

* Designation of Assigned Adult Representatives (a form which gives or denies permission for family members other than parent(s) to accompany your child to this office)

* Acknowledgement of Receipt of NOPP

* Consent for Release and Use of Confidential Information

Please read on to review our office policies, and again - WELCOME!

APPOINTMENTS

Dr. Morra will see patients according to the following schedule:

MONDAY 9 AM - 6 PM
TUESDAY 9 AM - 5 PM
WEDNESDAY OFF
THURSDAY 9 AM - 5 PM
FRIDAY 9 AM - 5 PM
SATURDAY 9 AM - 1 PM

Attempts will be made to see patients by appointment only. If you are unable to keep a previously scheduled appointment, you are asked to notify our office within 24 hours. There will be a $10 charge for "no-shows," that is, appointments which are missed for which we did not receive a phone call. This includes appointments which are made on the day seen ("same-day" appointments).

Walk-in appointments disrupt and delay Dr. Morra's and other patients' schedules, and are discouraged. If your child must be seen on an emergency basis, in the judgment of Dr. Morra, every effort will be made to accommodate you. Appointments on Saturday and those after 5 pm on Monday are intended to accommodate the working parent(s), and will be filled at the discretion of our staff. Patients will only be seen after-hours or on Sundays or holidays in cases of extreme emergency, in the judgment of Dr. Morra. Additional charges will be billed to you or your insurance company for emergency, after-hours, Sunday or holiday appointments.

Special note must be made for families with more than two children. We ask that you attempt to make appointments for only two children at a time, and bring additional children later on the same day or on another day.

TELEPHONE CONSULTATIONS

Remember that the phone should be used for brief discussion only. Anything further should be reserved for an office visit.

When you call our office, please give your child's name and as much information about the problem as possible. We will often err on the side of caution and advise you to bring your child in. Have a pen and paper available for any instructions given.

Some refills will be accommodated over the phone, but at the discretion of Dr. Morra and his staff, we will often ask you to bring your child in.

ANTIBIOTICS

Dr. Morra has a strict policy regarding antibiotics. Most infections, in some studies up to 80%, are caused by viruses for which taking antibiotics will not be helpful and could even be harmful. Overprescription of antibiotics can cause bacteria (NOT children) to become resistant to a particular antibiotic, thus making it even more difficult to treat.

Antibiotic prescriptions will NOT be called in without an office visit. Antibiotic prescriptions will NOT be refilled over the phone; an additional visit is required.

AFTER-HOURS CALLS

Dr. Morra knows that your children are dear to you, and that any illness or injury they may be experiencing may be considered an "emergency." However, problems that can be handled by close parental attention and/or over-the-counter medications should be handled as such. Prescription refills and discussion of minor problems should be handled during regular office hours. Dr. Morra checks his e-mail regularly and may ask a parent to use e-mail to keep in touch with him regarding a problem, but contact via this method should not be used routinely.

In cases where you believe a visit to the emergency department at St. Joseph's in Breese, or St. Louis Children's Hospital or Cardinal Glennon Children's Hospital in St. Louis is necessary, Dr. Morra asks that you call him FIRST. After hours, your call should be directed to the St. Joseph's Hospital switchboard (618-526-4511). The operator there will page Dr. Morra and, barring unforeseen circumstances, he will do his best to return your call within 15 minutes.

Your cooperation in limiting after-hours calls will be appreciated by Dr. Morra and his family.

REGISTRATION

Upon arriving at our office for your first appointment, you will be asked to complete a "Patient Registration" form, as well as a detailed Health History form regarding your child. Each subsequent visit, you will be asked to confirm or update this information. You should let us know of any recent changes in address, phone number, employer, insurance company, or health history (if we are not already aware of it). It is your responsibility to make sure that the insurance card we have is the one that is in effect at the time of the visit. Any errors in our system may leave you with unwanted financial responsibilities. It is a good habit to show us your current insurance card with each and every visit to our office. This is especially important with patients insured by Illinois Healthcare and Family Services (formerly known as IL Department of Public Aid, or DPA). We must see your IL HFS card with every visit.

SPECIAL NOTE ABOUT MINOR PATIENTS - Since we are a pediatric practice, we, by definition, take care of patients who are minors. As a policy, we require that an adult be present with EVERY patient under the age of 18 when he or she is seen in our office. We need to have written consent by every patient's mother and/or father as to whom may bring their child in the office in cases of well or sick visits - this consent is included in your initial registration packet. The "adult" must be over the age of 18 and designated on the Assigned Adult Representative form.

Doing this during your initial registration removes any doubt that may come up later.

FINANCIAL POLICY

We do everything we can to hold down the cost of medical care. You can help in this regard by eliminating the need for us to bill you. The following is a summary of our payment policy.

All payment is expected AT THE TIME OF SERVICE unless other prior arrangements are made with Dr. Morra.

This includes payment of applicable coinsurance and copayments for participating insurance companies. RFTS accepts cash, personal check (Illinois or Missouri addresses only), VISA, MasterCard, Discover, or debit cards.

Patients with an outstanding balance of ninety (90) days overdue must make arrangements for payment prior to scheduling appointments. If there is a significant financial hardship, you are encouraged to discuss it with Dr. Morra. You may be encouraged to save money by going to your county health department to receive vaccinations until your financial situation is resolved.

We bill insurance companies electronically as a courtesy to you. You are expected to pay your copayment(s) and/or deductible at the time of service. If we have not received payment from your insurance company within 60 days of the date of service, you will be expected to pay the balance in full. You are responsible for all charges. We will not bill secondary insurance companies, but you may submit our charges to these companies if you choose.
Your time of service receipt includes all information necessary for submitting claims to your insurance company.

We realize that there may be times when hardship may cause a concern about the payment of fees. Feel free, personally and privately, to discuss these concerns with Dr. Morra; he will understand. Any suitable arrangement will be considered. Written acknowledgement of such an arrangement will be required to include in the chart.

If you have questions or need any assistance with billing questions, please call the office during regular business hours.

Overpayments will be refunded upon written request to the responsible party within 30 days.

REFERRALS - Managed care insurance plans (i.e. HMOs) often require a referral from our office BEFORE seeing a specialist or visiting a laboratory or radiology facility. It is your responsibility to determine whether a referral is necessary. If you have seen a specialist without a referral, but require one based on your health plan, you will NOT be issued a retroactive referral. You will be financially responsible for that visit.

This includes chiropractic visits. Dr. Morra's policy on chiropractic visits may be found on www.dmorra.yourmd.com, and they are included here as well.

I believe there is a role for chiropractors in our community. When it comes to pain and musculoskeletal problems AND MEDICAL OPTIONS HAVE BEEN EXHAUSTED, I believe a chiropractor or acupuncturist could be considered. Referral to a chiropractor will ONLY be issued by me if a patient has seen an orthopedist, neurologist, and/or a physical or massage therapist first.

As relates to some chiropractors' beliefs that they can affect medical processes with spinal manipulation, I am a staunch opponent of the chiropractic field. In my medical opinion, babies cannot be cured of colic by chiropractic. Allergies and asthma cannot be cured or affected by chiropractic. Manipulation by a chiropractor cannot prevent devastating childhood illnesses, which many studies have shown necessitate the administration of vaccines such as DTaP, Hib, polio, MMR, Varivax ("chicken pox vaccine"), Prevnar (pneumococcal vaccine), Hepatitis A, and Hepatitis B.

Chiropractors can be used to affect changes in the musculoskeletal system, just as an optometrist treats the eyes or a podiatrist treats feet. However, when they start extending themselves and claiming that manipulation can affect the physiology of the body (i.e. how the body systems work), I think they are extending themselves too far. This is similar to me claiming that I am an expert on infectious diseases or pediatric surgery. I don't claim to be able to do more than I know or to able to do more with medicine than can be done. Chiropractors should not do that either.

If you would like to discuss chiropractic care with me further, please call the office to make an appointment.

FEES - Dr. Morra is committed to providing the best medical care for your children. His fees are usual and customary for our area, and he believes that they are fair and reasonable. Unfortunately, some insurance companies cut back on expenses by discounting the usual and customary fees paid to us without any explanation to you or Dr. Morra. This is a cost-cutting measure for them, and not a direct implication that Dr. Morra's fees are unfairly high.

Fees for other services provided by our staff-

PAST DUE ACCOUNT (STATEMENT SENT TO YOU)
$10

PHYSICAL FORM (WITH VISIT)
NO CHARGE

PHYSICAL FORM (OTHER TIME)
$20

SPORTS OR CAMP FORM (WITH VISIT)
NO CHARGE

SPORTS OR CAMP FORM (OTHER TIME)
$20

PRESCRIPTION REFILL (WITH VISIT)
NO CHARGE

PRESCRIPTION REFILL (OTHER TIME)
$5 EACH PRESCRIPTION

MISSED APPOINTMENT (NO CALL/NO SHOW)
$10

RETURNED ("BOUNCED") CHECK (AND BAD DEBIT PAYMENTS)
$25

As mentioned previously, there are additional charges for after-hours, Sunday, holiday, and emergency visits. These charges are in addition to the usual charges for service.

Please note also that "quick looks" in a patient's sibling's ears or throat will count as an additional office visit, and a copayment for that sibling will have to be paid.

Thank you for taking the time to read and understand our general and financial policies.
Poison Control (800-222-1222)


If your child has ingested something that you believe to be a poison, do not induce vomiting. You may call Dr. Morra, or call the Poison Control Center at (800) 222-1222.

Patients with Medicaid (Illinois Public Aid)


Medicaid will NOT be accepted as a secondary insurance at Dr. Morra's office.

A secondary insurance should function to "pick up the slack" for any costs that a primary insurance does not pay. However, the Illinois Department of Healthcare and Family Services (HFS) apparently does not feel it is necessary to pick up this slack.

For example, when HFS should pay a copay for a patient who has a primary insurance, they do not do so. Many other services that are not covered by a primary insurance are not covered by HFS.

Dr. Morra, then, basically provides medical services for free. Although this is a nice thing, it is also not fair to Dr. Morra or other patients who do have to pay for services.

The fairest way to deal with this problem is to have patients who have Medicaid as a secondary be required to pay the balance on their account after their primary insurer processes the claim. This includes copays.

Dr. Morra and his staff appreciates your understanding in this matter.

National Health Service Corps


Dr. Morra practices in a Federally Designated Healthcare Professional Shortage Area. His office is designated as a preferred site for the National Health Service Corps (NHSC). This designation will remain in place through September 2009.

As a NHSC provider, Dr. Morra agrees to see patients without regard for ability to pay. If a patient does not have insurance and does not have Medicaid, his/her family can provide financial information to the office and possibly qualify for a discounted fee scale.

If you believe you qualify for such a program, let Dr. Morra or his staff know.