Forms & Policies
Learn about the policies that help us provide your children with the very best of care.
Learn about the policies that help us provide your children with the very best of care.
These forms can be filled out online and securely submitted via our website. If you prefer, you may also print, complete and mail the forms to the office. We do ask that all information be completed and returned prior to your first appointment.
It is your responsibility to confirm we are in network with your particular plan prior to joining our practice. Since insurance companies have so many sub-plans, it would be impossible for us to list every plan in network.
We are pleased to offer safe and convenient online bill payment.
It is your responsibility to provide us with your current information for each visit. If we do not have the correct insurance information, you will be responsible for all charges
It is your responsibility to understand your contract with the insurance company regarding your share of the cost. We collect payment due at the time of service (self-pay/insurance not accepted) or when we receive insurance information about your share of payment. If you are not able to pay, a payment plan may be arranged upon request.
We require a payment card (debit, credit, FSA, HAS or HRA) to be kept on file. In the case of divorced parents, we cannot split fees between two cards. This card is stored by a secure payment processor. Your credit card number will be encrypted and we only have access to the last 4 digits of your card. If your card is not active at the time of service, whomever brings in your child is responsible for providing a new card and/or any payment(s) due.
We submit claims for services to your insurance company after each visit. They process the claim and tell us of the amount you owe. You will receive an EOB from the insurance company, and we will charge your card on file for the payments your insurance holds you responsible for, unless we have a payment plan established. If you dispute the charges to be applied to you, notify us immediately.
Accounts over 90 days will receive a non-payment notification. If this notice is not acknowledged within 7 days, we will assume you no longer want your children to be cared for by us. You will receive a transfer form to establish with another physician’s office, your account will be sent to collections, and Saugatuck Pediatrics LLC will no longer be involved in the billing/collection process.
We require that your child have regular physical exams (per our infant/toddler schedule, then once yearly starting at age 3) to remain a part of the practice. We practice medicine (including developmental screens, hearing/vision tests and vaccinations) as outlined by the American Academy of Pediatrics. If there is a recommended screen or test that is not covered by insurance, we will still require that it be done at the time of visit. If your child sees an eye doctor or audiologist regularly, we will waive the vision and/or hearing exam.
If there is a separate significant medical issue covered at the time of your child’s annual visit, that would normally require a separate visit and co-pay, we are required by insurance to bill for an additional “sick” visit. This may incur a co-pay. Alternatively, if appropriate, we can address issues that require additional time at a separate visit.
We are happy to assist you during office hours for all appointment types. If your child needs a same day appointment we prefer you call us.
You can also send an appointment request through the MyKidsChart patient portal for non-urgent issues only. Please let us know:
Allow two business days for us to return your message.
To give us time to check you in, confirm demographic info, verify insurance, and collect co-pays and balances, we ask that you arrive five minutes before your scheduled appointment time. If you are coming for a well visit, and have not completed CHADIS and/or the previsit questionnaire, we ask that you arrive 15 minutes prior.
We understand, of course, that sometimes things happen that may prevent you from arriving that early. Or even on-time. We’re happy to be flexible, but we also need to keep other patients and their appointments running on schedule.
Everyone hates to wait, especially in a doctor’s office. While we try hard to create a patient-friendly atmosphere, we also do not want to allow one patient’s lateness or sibling add-ons to affect our other patients’ time with the physician.
We recognize that there is much anti-vaccine rhetoric in the press today that has heightened parents’ concerns regarding immunizations. However, there is no scientific link between vaccines and autism or the other issues claimed by the anti-vaccine crowd. Thus, we feel it necessary to take a firm stand on the vaccine policies in our practice.
The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.
Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR (measles, mumps, rubella) vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of under-immunization, there have been multiple outbreaks of measles and several deaths from complications of measles in the United States and worldwide over the past several years. The United States experienced a record number of measles cases during 2014, with 667 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.
Furthermore, we firmly believe that by not vaccinating your child, you are taking advantage of thousands of others who do vaccinate their children, which decreases the likelihood that a child will contract one of these diseases. Even delaying or “breaking up the vaccines” to give one or two at a time over additional visits goes against expert recommendations, is not supported by any scientific data, can lead to unnecessary delays and errors, and can put your child, other children, and adults at risk for serious illness (or even death). It is therefore against our medical advice as professionals at Village Pediatrics.
As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We are more than willing to discuss any questions you may have about vaccines, but do require all new patients to our practice to adhere to the vaccination schedule endorsed by the American Academy of Pediatrics (AAP) unless they meet the following criteria:
What if we’ve missed doses of vaccine, but are willing to vaccinate?
If a newborn did not get the Hepatitis B vaccine in the hospital for whatever reason, we will give it at the first office visit and continue on schedule.
If a child transfers in to our office and requires a catch-up schedule, we will catch up according to the CDC catch up schedule.
Too many too soon?
For those who are worried that there are too many vaccines too soon and they will overwhelm the immune system: This fear is simply unfounded. The schedule has been shown to be safe. We are exposed to a few hundred thousand viruses and bacteria each minute through normal breathing. Children receive about 130 antigens from vaccines. This is not a significant number compared to the millions upon millions of viral and bacterial antigens that enter a child’s lungs daily. The number of antigens has dropped over the same years that the number of illnesses being prevented has increased.
Law of unintended consequences
Separating vaccines also requires more visits to our office, which can expose children to more illness and unnecessarily increases the cost of healthcare.
Studies have shown that the first injection causes a stress response (measured by elevated heart rate, blood pressure, cortisol levels, cry), but subsequent injections given at the same time do not increase as significantly the stress when compared to returning on different days to get further injections. So children with delayed schedules are actually subjected to more stress.
We are more likely to suffer death from car accidents than to have an adverse reaction to a vaccine.
As Paul Offit summarized in Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?:
Current studies do not support the hypothesis that multiple vaccines overwhelm, weaken, or “use up” the immune system. On the contrary, young infants have an enormous capacity to respond to multiple vaccines, as well as to the many other challenges present in the environment. By providing protection against a number of bacterial and viral pathogens, vaccines prevent the “weakening” of the immune system and consequent secondary bacterial infections occasionally caused by natural infection.
We are happy to process prescription refill requests for chronic conditions when needed. Refill requests are typically processed within 3 business days.
If you need an urgent refill, please follow these directions and then call the office to alert us to the urgency of your need.
If you need a medication refill but are behind on visits, please call the office to set up an appointment ASAP, and your primary physician will make a decision about extending the refill pending a future visit.
For medication refills, please have your medication bottle/package available for details. Go to the patient portal and send a medication refill request with the following information:
Often children with ADHD and other psychiatric diagnoses require specialty care by a child psychiatrist or behavioral-developmental pediatrician. Some children can be diagnosed and followed here in our office by the pediatricians at Saugatuck Pediatrics. Your child’s pediatrician will work with you to decide if it is appropriate for them to help with diagnosis and management of your child’s condition.
Because the medications used to treat ADHD are controlled substances, and other psychiatric medications require regular follow up, we have had to establish a policy for follow up visits and how we provide those prescriptions.
If you would like your child’s pediatrician to help with diagnosis or management of ADHD or other psychiatric conditions, please read our policy, sign and submit.
Saugatuck Pediatrics LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Saugatuck Pediatrics does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Saugatuck Pediatrics LLC:
If you need these services, contact Saugatuck Pediatrics Civil Rights Coordinator at email@example.com.
If you believe that Saugatuck Pediatrics has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Dr. Jennifer Gruen, Managing Partner
Saugatuck Pediatrics LLC
191 Post Road West
Westport, CT 06880
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available online, or by mail or phone at:
Get Help in Other Languages
If you need help or speak a non-English language, call our office at 203-221-7337, or call toll free 800–368–1019 (TTY: 1-800-537-7697), and you will be connected to an interpreter who will assist you at no cost.
191 Post Road West, Suite 201
Westport, CT 06880
We are located in the Connecticut Children’s Medical Center building, off the street and behind Schulhof Animal Hospital.
Non-urgent medical or administrative messages can be sent through our patient portal. We will respond within 2-3 business days.
Sick visit requests may also be made through the portal on weekdays only.
Monday - Friday
8:30 am - 12:00 pm
1:30 pm - 5:00 pm
We offer urgent visits in the mornings only. Please call the office by 10 am for an appointment.
If your child’s illness or injury is life-threatening, please call 911.
For urgent after hours concerns, call our office. Our clinicians are on call 24/7.
Poison Control Hotline