Office Forms & Policies
Be prepared for your upcoming appointment with Phillips Pediatrics!
For your convenience, patient registration can be completed online or you can download forms here.
Online Forms
- Online Family Registration (Required for Each Family)
- Online Medical History Questionnaire (Required for Each Child)
- Online Authorization for Release of Medical Records to Phillips Pediatrics
Download Forms
To view the forms listed below, you will need to download Adobe Reader. Please bring your completed forms with you to our office at the time of your visit.
- Family Registration
- Practice Policies (Privacy, Financial, Treatment)
- Notice of Privacy Practices
- Medical History Questionnaire
- Authorization for Release of Medical Records
- Marketing Release Authorization
Visit Forms
For your convenience, individualized visit forms are attached to your child’s online portal.
Online Portal
Billing & Insurance
We take all major insurances, including private, MS Medicaid, and CHIP plans. We are in network with many insurance companies. We also have a self-pay plan with discounted rates for uninsured patients.
Phillips Pediatrics is currently in network with Aetna, Blue Cross Blue Shield, CIGNA, Coventry, First Health, Golden Rule, Health Scope, Humana, Mail Handlers, MS Medicaid, Magnolia, Molina, Molina CHIP, UnitedHealthcare, UnitedHealthcare MSCan, UnitedHealthcare MS CHIP, and some TriCare plans.
If you do not see your plan listed, please check your insurance network or call our billing office as we may be in a network not listed above.
TriCare Select covers at 100%. Until TriCare opens their network, TriCare Prime is covered out of network at 50%. TriCare East is not covered.
Medishare and other share plans are not accepted. These plans often put payments to patient responsibility. Instead, we offer a self-pay plan at discounted rates. We are happy to provide reports for families who wish to file their own claims with share plans.
While we are in network with many insurance plans, it is the family responsibility to ensure we are in network with your plan. Some plans, such as Cigna MS Connect and UHC HMO, have a limited provider network. While most plans cover vaccines and preventive care checkups, some have limited benefits or restrictions on time of service. It is the family responsibility to ensure your plan covers the cost of checkups and vaccines.
Many private plans have co-pays or high-deductibles. It is the family responsibility to know your plan and provide required payments of those plans at time of service.
Please refer to Phillips Pediatrics policies for further information on insurance and our financial policy.
Frequently Asked Questions
Yes! Dr. Phillips is currently accepting new patients.
HIPPA requires an authorization for consent of medical records between institutions and providers. For your convenience, we’ve included a transfer of records request here.
We take all major insurances, including private, MS Medicaid, and CHIP plans. We are in network with many insurance companies. We also have a self-pay plan with discounted rates for uninsured patients.
Phillips Pediatrics is currently in network with Aetna, Blue Cross Blue Shield, CIGNA, Coventry, First Health, Golden Rule, Health Scope, Humana, Mail Handlers, MS Medicaid, Magnolia, Molina, Molina CHIP, UnitedHealthcare, UnitedHealthcare MSCan, UnitedHealthcare MS CHIP, and some TriCare plans.
If you do not see your plan listed, please check your insurance network or call our billing office as we may be in a network not listed above.
TriCare Select covers at 100%. Until TriCare opens their network, TriCare Prime is covered out of network at 50%. TriCare East is not covered.
Medishare and other share plans are not accepted. These plans often put payments to patient responsibility. Instead, we offer a self-pay plan at discounted rates. We are happy to provide reports for families who wish to file their own claims with share plans.
While we are in network with many insurance plans, it is the family responsibility to ensure we are in network with your plan. Some plans, such as Cigna MS Connect and UHC HMO, have a limited provider network. While most plans cover vaccines and preventive care checkups, some have limited benefits or restrictions on time of service. It is the family responsibility to ensure your plan covers the cost of checkups and vaccines.
Many private plans have co-pays or high-deductibles. It is the family responsibility to know your plan and provide required payments of those plans at time of service.
Please refer to Phillips Pediatrics policies for further information on insurance and our financial policy.
Most hospitals ask if you have a pediatrician when you go in to deliver. Your baby’s first examination will be with a pediatric hospitalist or on-call pediatrician. Upon discharge, either you or the nursery will need to schedule a newborn visit with Dr. Phillips.
Dr. Phillips will see your baby 2-3 days after discharge and regularly after that for checkups.
You typically have 30 days after birth to enroll your child in an insurance plan. We hold claims the first month of life as most plans backdate to birth.
Pediatricians devote their entire careers and training to the care of children. They undergo a minimum of three years of pediatric training after graduation from medical school. Pediatricians manage the health of your child, including physical, behavior, and mental health issues. Pediatricians work with parents to give guidance, support, and reassurance and should be a doctor with whom you trust and feel comfortable. In addition to routine health maintenance, we are the first person to call whenever you have a question or when your child is sick. The American Academy of Pediatrics recommends your child see a pediatrician from birth to the age of 21.
The foundation of osteopathic medicine is that people are more than just the sum of their body parts. Osteopathic physicians are known to take a hands on approach to diagnosis, a holistic approach to care, and a systems-based approach to treatment. There are 5 aspects of personal health: physical, emotional, social, spiritual, and intellectual. Osteopathic medicine focuses on the well-being of the entire person. This holistic approach to care has been a guiding principal for Dr. Phillips as a D.O.
Yes. We diagnose and manage ADHD as well as other common pediatric mental health issues, such as oppositional defiant disorder, depression, and anxiety. We have a counselor on site that allows for comprehensive care in the comfort of your pediatrician’s office. We also coordinate care with specialists and schools when needed. For optimal health, we require our ADHD patients to stay up-to-date with routine healthcare maintenance and vaccinations.
Yes, we are contractually obligated to collect insurance co-pays for each patient we see. For this reason, we require co-pays at the time of each visit. The person bringing your child to the office is responsible for the payment.
Private insurance plans vary. It is your responsibility to know your plan. CHIPS co-pays are listed on the back of your child’s insurance card.