Patient Forms

Forms can be completed online through the patient portal or you can print them from our website and bring them with you to your appointment.

Insurance Navigation Tips

Disclaimer:
These are just a few tips we have found helpful in the past.
This is not a legal document.

Key Terms You Should Know:

Co-Pay*: If you have a co-pay on your plan, this is the set fee that you must pay when you use the plan. We will ask you for this payment at the beginning of your child’s visit.

Deductible*: This is the amount that you must pay before the insurance will begin to pay. Many plans will allow you to choose your own deductible, if this is the case keep in mind that the higher the deductible, the lower the premium will be.However, the higher the deductible, the more you will have to pay when you use the plan.

Co-Insurance*: After the deductible there might also be a co-insurance. This means that you and the insurance company will share the cost of your remaining fees. The co-insurance is typically broken down by percentage like 80/20 or 70/30. If you choose a plan that has a 80/20 co-insurance, typically you will be in charge of paying 20% and the insurance will be in charge of the other 80%.

In-Network, Out-of-Network: Medical facilities and practitioners that have contracted with the insurance companies to provide discounted rates, direct billing and other services are considered In Network. Those facilities that have not contracted are considered “Out-of-Network.” The insured will typically save money by using “In-Network” providers and facilities.

Out of Pocket Expense: This is the amount of money that you will pay towards your medical expenses. After your Out of Pocket Maximum is met, your insurance company will pay 100% of all covered charges for the rest of the year (or plan year). Your out of pocket expense is usually in the form of a deductible, co-insurance, copay or some combination of the three.

*Forest Lane Pediatrics offers a convenient way to make payments on your child’s account, called Credit Card on File. At the time of check-in, your credit card can be electronically stored in encrypted form. After the claim for that visit has been processed, your card will be charged for any remaining charges pertaining to that visit. On all subsequent visits, you will be able to use for your card on file for copays and deductibles. You may choose to use your credit card on file or other form of payment for copay. You will be notified by email of pending charges 5 days before the charges occur, and again when the credit card is charged. If you have any questions about the charges you will have 5 days to contact our office before the credit card is charged. (Note: Your copay must be paid at time of visit)

 

Tips To Help Your Visit Go Smoothly:

1. New Insurance? If you have new insurance, call Forest Lane Pediatrics to update your insurance information as soon as possible, especially if your child has an upcoming appointment. This will allow our staff to verify your child’s insurance coverage prior to the appointment and minimize wait time in the office. You will also need to call your insurance company to confirm Coordination of Benefits (see # 3 below).

2. New Baby? In the first month of your baby’s life, he or she will be seeing the doctor to monitor growth and to make sure that he or she is healthy. If your newborn gets sick during the first month of his life, you will be in the doctor’s office even more. It is important to understand your insurance, and to make sure you know how to add your child to your health coverage so that there are no problems with overlapping or non-coverage. Every insurance company is different. Don’t just assume that because you are being covered by an insurance company that they automatically add your child to your plan. Your very first step should be to contact your insurance company to gain a complete understanding of the steps you will have to take. Most often, you will be required to call them within a few days of delivery to add your baby to your plan. Also, check with your human resource administrator to make sure all steps have been taken to add baby to your insurance policy. In most instances, there is a grace period of 30 days to add your baby to the coverage. This is what is referred to as automatic coverage. However, some plans do not offer automatic coverage for your baby, and in most cases, you must add baby to your plan before the automatic coverage window expires in order for any claims to be paid. If you do not add baby to the policy within the required time frame, all of baby’s medical claims will be denied by the insurance company and will be your responsibility.

 

(Now for the really confusing part!)

3. Do Both Parents Carry Insurance Coverage for Your Child? Most health insurance
contracts have a clause that allows the benefits of one policy to be coordinated with the
benefits of other policies. This clause, referred to as Coordination of Benefits (COB), prevents
duplicate payment of health care services. The COB rules follow guidelines established by
the National Association of Health Insurance Commissioners (NAIC).
A. Children covered under more than one plan, with the parents married or living
together:
• The policy of the parent whose birthday (month and day) is earlier in the year
is primary.
• If the parents share the same birthday (month and day), the policy with the
earlier effective date is primary.

B. Children covered under more than one plan, with the parents divorced or living apart:
• The policy of the parent that the court has made responsible for health care
insurance is primary.
• The policy of the parent who has custody of the children is primary.
• If the court has not placed responsibility on one parent to insure the children and the parents have
joint custody, the policy of the parent whose birthday (month and day) is earlier in the year is
primary.
• If the parents share the same birthday (month and day), the policy with the earlier effective date is
primary.
• If you have Tricare and Commercial insurance, the Commercial insurance is always primary.

 

4. What does it mean to “Update the Coordination of Benefits”?  When a staff member at Forest Lane Pediatrics tells you that your child’s claim was denied due to Coordination of Benefits (COB), they will ask you to call your insurance company, update the COB and ask your insurance company to re-file the claim. This means that you need to let your insurance company know that your child is only eligible for one insurance plan, or verify which insurance is the primary insurance BEFORE THEY WILL PAY ANY CLAIMS. Please note, Forest Lane Pediatrics does NOT file claims to secondary insurance, but we are happy to give you a detailed receipt that you can file directly to secondary insurance plans.

 

5. When do you need to call your insurance company to update your child’s Coordination of Benefits?
A. After any request for clarification from your insurance company.
B. At the request of Forest Lane Pediatrics.
C. Any time you switch insurance plans for your child.
We recommend that you ask for a reference number any time you have a conversation with your insurance company! If at all possible, you can also request written confirmation via letter or e-mail.

Still have questions? Call us!
Dallas office (972) 284-7770
Plano office (972) 526-0700

Patient Feedback

Review Us

We want to thank you, our valued patient, for taking the time to tell us about your visit.


Mom Approved Docs and D Magazine Best Pediatricians

The following doctors have been recognized by DFW Child Magazine as Mom Approved Doctors during their time at Forest Lane Pediatrics:

Ronald M. Blair, MD
R. Adrian Clarke, MD
Diana V. Dickschat, MD
Michelle B. Kravitz, MD
Ann J. Liu, MD
Isha Mannering, MD
Chris M. McGonnell, MD
Damien H. Mitchell, MD
Chris J. Straughn, MD
Lily H. Strong, MD

The following doctors have been recognized by D Magazine as Best Pediatricians in Dallas during their time at Forest Lane Pediatrics:

Ronald M. Blair, MD
Michelle B. Kravitz, MD
Ann J. Liu, MD
Chris M. McGonnell, MD
Damien H. Mitchell, MD
Chris Straughn, MD


Testimonials

“My son has been going there for the past 1.5 years. I interviewed Dr. Straughn when I was pregnant and really liked him. Dr. McGonnell took care of my son at Plano after birth so I decided to regularly go to him and I have been very impressed with his knowledge on medical topics and just giving advice in the early days. Most of these doctors have kids of their own so they are very familiar with the issues at hand.”
Verified Patient

“We’ve had such a fantastic experience with Dr. Straughn. He has been my daughter’s pediatrician for the past three years and has been so supportive, kind, and helpful. We’ve also seen Dr. Clarke and Dr. Kravitz for sick visits, and both were wonderful to work with. Love Forest Lane Pediatrics.”
Ashley B.

“Dr. Samara and his staff are great! When one of my children is sick, I have been able to get them in to see the doctor within hours of calling. The nursing staff are also wonderful and are available to answer questions over the phone. Very warm, caring, yet professional atmosphere. (My 2.5-year-old son also loves the fish tank in the waiting room.) Thanks for taking such great care of my kiddos Pediatric Place!”
Kate H.

“Dr. Straughn is wonderful! And his staff is always courteous and helpful. Yes, there is usually some wait time but there is always a wait when you’re seeing a doctor. I couldn’t have chosen a better doctor for my son! To Dr. Straughn and his staff… YOU ARE AN AMAZING GROUP, THANK YOU FOR ALWAYS GOING ABOVE AND BEYOND FOR YOUR PATIENTS!
Verified Patient

“Moms and Dads out there…Look no further…This is the place you want to take your children! We adore Dr. Mitchell but all of the staff is top notch. They are caring and thorough. They are helpful and comforting. Best pediatric staff in the Metroplex. I knew I had made a great choice when all of my friends said to me, “We go there too!!” I have referred Dr. Mitchell to MANY friends and all are very very happy!!! Don’t waste time, call them today!”
Lori T.

Office Protocol

Office Protocol

Forest Lane Pediatrics would like to welcome you to our pediatric office. The office protocol information below outlines how our practice operates. If you have any questions about these policies, please do not hesitate to ask.

Sick and Well Waiting

We have provided sick and well waiting areas for your convenience. If you come to the office with more than one child and one of your children is sick then you must report to the sick waiting room. Children who are here for a well exam, recheck or follow-up exam from a previous illness may present to the well waiting room. Thank you in advance for your cooperation in this matter.

Immunization Policy

Our physicians believe that all children should be fully immunized unless there are medical contraindications. Therefore, you will need to bring a copy of your child’s immunization records to the first visit in order to be seen. We are unable to accept new patients/families unless they are willing to fully comply with the recommended timetable for vaccine administration per the American Academy of Pediatrics. We believe this policy advocates for children and their best interest.

Automated Phone System

Our office uses an automated phone system to help direct telephone traffic. Please note the prompts as you listen to the system. Phones will be turned on at 7:00 A.M. and turned over to the answering service at 4:30 P.M on weekdays. On Saturdays, the phones will be on from 7:30 A.M. – 10:00 A.M. A few notes about the phone system:

  1. Phone messages are prioritized according to urgency.
  2. Appointments requiring an exam that day will be answered within a 1 hour time frame.
  3. Non-urgent calls will be answered within 2-3 hours.
  4. Lengthy calls, such as: Feeding, sleeping, or behavioral questions will be answered by the end of the day.
  5. The prescription request or refill line will be answered hourly.
  6. The referral line will be checked daily – you are responsible to know if you need a referral to see a specialist. Please call the referral line 72 hours in advance of the needed referral.
  7. Medical record requests left on the phone system will be answered daily. Please allow 72 hours to have records available and these can be picked up, faxed, or mailed. We will not send out any records without a signed records release form. For complete medical record requests, please see the “Medical Record” section.
  8. If your regular doctor is busy or out of the office and your child is sick and needs an urgent appointment, he or she may need to see a different doctor. All well exams will be scheduled with your regular physician.

If your regular doctor is busy or out of the office and your child is sick and needs an urgent appointment, he or she may need to see a different doctor. All well exams will be scheduled with your regular physician.

Email Policy

E-mail questions submitted via the Patient Portal will be answered by the following business day. We ask that only the Patient Portal be used for electronic communication with our office in regards to medical information about your child. Communication through the Patient Portal is encrypted, and therefore protected against hacking. E-mail communication directly through the website is not encrypted and should only be used for communication that does not contain any personal or medical information. We will ask you to fill out an e-mail policy form that states what will be addressed via e-mail response in order to comply with HIPPA regulations.

After Hour Calls

When calling after hours you will have the option of speaking with a Pediatric Nurse from Medical City Children’s Hospital for free, or you may elect to speak to the on-call physician for a fee of $25. The nurse will be happy to answer any questions and give advice regarding the care of your child, but the nurse will not have access to your child’s chart and can’t prescribe any medications or authorize any refills. Should you need to speak with the on-call physician to follow up on an issue for which you were seen that same day, the fee will be waived. When possible, Forest Lane Pediatrics will bill your insurance for any after-hours charges.

Late Policy

If you are more than 15 minutes late for your appointment, you may be asked to reschedule for a later date. If your child is sick, you may wait in the office and be worked in between patients. Please note there will be an extended wait time if you are late for your appointment.

Same Day Appointments

We will attempt to accommodate all same day sick visits requested before 3 pm, however, there may be a wait time as we will be working you in between regular scheduled appointments.

Forms

Various forms and letters are often lengthy and may take extra time to be filled out. Please allow up to 3 business days for forms or letters to be completed by our office. There will be a $15.00 charge for letters or forms needing more than a signature.

Medical Records

There will be a $6.50 charge for copying of your child’s chart or transferring your child’s chart to another physician.

Appointment No Show Policy

Failure to cancel your appointment within 24 hours notice will result in a $25.00 charge. This charge must be paid prior to scheduling your next appointment.

Thank You,

Forest Lane Pediatrics of Dallas, Plano and Mesquite

The office protocol will be updated periodically as the practice grows, and changes will be made accordingly.

Frequently Asked Questions

Frequently Asked Questions

Our list of Frequently Asked Office Questions should answer many of your general questions about our practice at Forest Lane Pediatrics of Dallas, Plano and Mesquite. Please contact us if you have additional questions or to make an appointment