Keiki Korner Pediatrics Office Policies

*Subject to change at any time

Office Hours: Monday, Tuesday, Thursday, Friday 8a– 5p.m. Wednesdays either 8a-12p or 8a-5p. We are open on designated Saturdays 8a-12p. Consult the “Calendar” tab for specific schedules.

Appointments: No Walk Ins. We see patients by appointment only.

After Hours and Emergencies: For a serious emergency call 911 right away. If you are not sure and you call our office, please be sure to tell the person who answers the phone that it is an emergency. For urgent matters after hours please call 808-782-5924. Please keep in mind that Dr. Agullana has a family of her own. She may not be able to answer pages immediately. If it is an emergency, go to the ER or call 911. The answering system is a privilege, and abuse of it will be dealt with accordingly.

Cancellations: Please call our office at least 24 hours in advance if you are unable to keep your scheduled appointment. This allows us to provide that time slot to another patient. If you arrive 10 minutes or more after your scheduled time for a physical, you will be rescheduled. If you arrive late for a sick visit, you can choose to wait, but will be seen after all other scheduled patients have been seen.

No Shows: Any new patient who no shows to a scheduled appointment will no longer be allowed to establish care with us.

Complete Shot Records: A physical exam will only be scheduled if complete shot records are available for review.

Vaccines: Vaccines are given according the CDC and AAP recommendations and guidelines.

Parents or Guardians: Patients under the age of 18 must be accompanied by a parent/legal guardain or responsible adult designated by the parent/legal guardian at all visits.

Complete Physical Exams: We believe that routine, annual complete physical exams with screening lab tests are very important to the maintenance of good health. However, insurance benefits vary. Some policies cover “wellness” and others cover visits when you have a complaint. Please learn about your benefits prior to your appointment so you will know what is covered by your insurance plan.

Test Results: If you have diagnostic testing, i.e., lab, x-ray, echo, ultrasound, sleep study, please schedule a follow-up appointment, within 7-10 days, to go over the results with your physician and you will be subject to your copay/coinsurance. Results will not be given over the phone.

Prescriptions and Refills:
•The best time to get a prescription refill is at your appointment.
• If you need to call for refills, don’t wait until you have run out. Most refills require the doctor’s approval.
Don’t go to the pharmacy to wait for your prescription to be called in. Call them first to see if it is ready.
• Refill requests may take up to 2 business days to be completed
• Some prescriptions cannot be called in. The prescription must be printed for you to pick up.
• Don’t call after hours for prescription refills. There is no access to your chart and we may not be able to help you.

Referrals: Referrals are handled by our Referral Department. Sometimes this can be done on the same day as your appointment and sometimes it can take 2-3 days, depending on your insurance and/or the urgency of your situation. Someone will contact you as soon as the referral authorization is obtained.
As a patient, it is your responsibility to ensure that your specialist is on your plan. It is also your responsibility to ensure your specialist receives your test results. You should pick-up a copy of your test results from our office and hand deliver them to your specialist. We will not fax test results and it is possible that the specialist will not see you without these. Please understand that it can sometimes take a few weeks to get an appointment with a specialist. This is not something we have control over.

Dismissal: If you are “dismissed” from the practice it means you can no longer schedule appointments, get medication refills or consider us to be your doctor. You have to find a doctor in another practice.
Common Reasons for Dismissal
• Failure to keep appointments, frequent no-shows
• Noncompliance, which means you won’t follow physician instructions about an important health issue
• Abusive to staff
• Failure to pay your bill
Dismissal Process
We will send a letter to your last known address, via certified mail, notifying you that you are being dismissed. If
you have a medical emergency within 30 days of the date on this letter, we will see you. After that, you must
find another doctor. We will forward a copy of your medical record to your new doctor after you let us know
who it is and sign a release form.

No Insurance: Payment will be due at the time of service. If you are unable to pay your balance in full, you will need to make prior arrangements with our Accounts Manager or a Customer Service Representative.

Insurance: Although we are contracted with several insurance companies, it is your responsibility to make sure that Dr. Agullana is in your plan. It is also your responsibility to know your insurance benefits. As a courtesy to our patients we will file primary insurance forms from our office. We do not file secondary insurance except for Medicare Recipients. In order to do this we will require information from you. We will need all your demographic and insurance information prior to your appointment. We will also request an update on this information approximately every six months thereafter. We ask that at the time of your appointment you bring your insurance card and a photo ID as well as any other forms that will assist in making sure that your claim is filed
correctly. At the time of service you will be responsible for all fees that are not covered by your insurance, including co-pays, co-insurance, deductibles and non-covered services or items received. The co-pay cannot be waived by our practice, as it is a requirement placed on you by your insurance carrier. We strive to be as accurate as possible in calculating your responsibility but, with so many variations in policies and fee schedules, we are not always exact.
You may receive a statement from our office for any balance due. For your convenience we accept cash, checks, credit cards (Visa, MasterCard).

Auto Accident: If your injury is a result of an auto accident, you are required to pay for services and then collect from the auto carrier. We will not file your insurance but will provide you with a receipt to do so.

Liability Injury: If your injury is a result from another party’s negligence, you are required to pay for services and then collect from the responsible party. We will not file your insurance but will provide you with a receipt to do so.

Worker’s Compensation: If your injury is due to an accident in your work place, please inform the receptionist immediately. We are not authorized to treat you for this type of claim. You will need to contact your supervisor for instructions on how to file a worker’s compensation claim. We regret any inconvenience this may cause.

Return Checks: There will be a charge assessed for any check returned by your bank for any reason.

Disability, Insurance Forms, Attending Physician Statements, FMLA: There will be a charge of $25.00 for the completion of medical forms or you may be required to schedule an appointment. Payment is due at the time that you pick-up these forms. Please allow 7-10 days for the completion of these forms. If you would like the forms mailed to you or the insurance, payment will be due prior to mailing. FMLA forms require that you come in for an

Medical Records: We will provide you a copy of your medical records upon request and for a $25 fee. You will need to sign a letter of release prior to having them copied. Please allow up to 30 days for this request to be processed.

Billing: If you receive a bill from us, it is because we believe the balance is your responsibility. Please contact your insurance company first, if you think there is a problem. If you have any questions about your bill, please call our billing department immediately. If you cannot pay your entire balance, please call to make payment arrangements.

Collections: Accounts that are not paid within 30 days begin our in house collection process. If your balance becomes 65 days old, your doctor will be notified and you may be subject to dismissal from the practice.