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Billing & Insurance We make it easy to pay your bill. If you have questions or inquiries about your bill, please contact our billing office using the information below. Pay your bill online Hours & Contact Monday – Thursday: 8:00 AM – 4:30 PM Friday: 8:00 AM – 4:00 PM Phone: (952) 230-9740 Good Faith Estimate You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost. Click here to learn more. Price Transparency Important Information Regarding Your Bill Frequently Billed Services We have a team of dedicated billing specialists to help answer your billing questions. It is greatly appreciated if you pay your copays and deductibles at the time of service and any patient statement received in the mail within 30 days. If you need additional assistance, please ask for the billing supervisor. Every insurance plan is different. If you disagree with the amount your insurance paid out, please contact them prior to contacting our office. Appointment Cancellation Policy We strive to see all patients who schedule appointments with us and to stay on-time unless another patient's medical situation delays us. We will try to keep you informed if this occurs. Recently, we have experienced a significant increase in "failed" appointments where we did not receive sufficient cancellation notice. As such, we ask that you provide us with a 24 hour notice of any planned changes to your appointment – whether it be a rescheduling or a cancellation. Please note that you will receive a $50.00 self-pay charge if we do not receive this notice from you. Thank you for helping us to remain accessible to you and others! Insurance Coverage of Our Services We make every attempt to accept as many insurance plans as possible, but know that there are many unique and new plans that change frequently. To see if we are in your network or to check if a particular service is covered, please contact your employer, their human resources department, or your insurance company by calling the number on your card. Some plans require that you designate a primary care clinic. To obtain coverage in cases like these, Wayzata Children's Clinic must be selected. Our referral coordinators in Minnetonka can help guide you, and they are available at our main number, 952-473-0211 . Common Questions and Concerns How much do I really owe? You are responsible for the amount listed in the box PATIENT BALANCE. What's a deductible? This is the yearly dollar amount that you are responsible for based on the type of coverage you or your employer have selected. It is due at the time of service or within 30 days of receipt of a patient statement. What's a co-pay? This is the dollar amount contracted between you and your insurance carrier. It is due at the time of service. What's co-insurance? This is a percentage of the insurance benefits that you are responsible to pay. What's an adjustment? This is a contractual agreement that has been made between our practice and your insurance company. Billing and Collection Policy Our Billing and Collection Policy is posted to comply with Minn. Stat. 62J.806, which requires healthcare providers to publicly disclose their medical debt collection procedures. Click here to learn more. Locations Chaska (952) 448-3847 Location & Hours Delano (763) 230-2780 Location & Hours Maple Grove (763) 324-8000 Location & Hours Minnetonka (952) 473-0211 Location & Hours Save time. Book online! Book Now Locations Chaska (952) 448-3847 Location & Hours Delano (763) 230-2780 Location & Hours Maple Grove (763) 324-8000 Location & Hours Minnetonka (952) 473-0211 Location & Hours Spring Park (952) 495-8910 Location & Hours Save time. Book online! Book Now

At Wayzata Children's Clinic, our number one priority is the health and well-being of your child. We welcome new patient families and offer a free, one-on-one appointment with one of our pediatricians or nurse practitioners to better acquaint you with our clinics, staff, and practice. Call any of our clinic locations to schedule a get acquainted visit. New Patient Forms We accept a wide variety of insurance. Please confirm that your insurance is accepted by calling the benefit department at your insurance company. New Patients General Consent Form, HIE- FAQ Get Form Important Information Regarding Your Bill Get Form Integrative Medicine Intake Get Form New Patient Intake Form Get Form Notice of Privacy Practices Get Form Patient Portal Enrollment Form Get Form Patient Portal Frequently Asked Questions (FAQ) Get Form Patient Portal Terms of Service Get Form Locations Chaska (952) 448-3847 Location & Hours Delano (763) 230-2780 Location & Hours Maple Grove (763) 324-8000 Location & Hours Minnetonka (952) 473-0211 Location & Hours Save time. Book online! Book Now Locations Chaska (952) 448-3847 Location & Hours Delano (763) 230-2780 Location & Hours Maple Grove (763) 324-8000 Location & Hours Minnetonka (952) 473-0211 Location & Hours Spring Park (952) 495-8910 Location & Hours Save time. Book online! Book Now

SELECT FORM TYPE: Forms ADHD Cardiac History Questionnaire Get Form Asthma Control Test Get Form Childhood-Asthma Control Test Get Form Consent Form to Verbally Release Health Information Get Form Coordination of Care Release Get Form Frequently Billed Services Cost Get Form GAD-7 – Generalized Anxiety Disorder 7 Item Get Form General Consent Form, HIE- FAQ Get Form Health Care Summary Form Get Form Important Information Regarding Your Bill Get Form Integrative Medicine Intake Get Form M-CHAT (Modified Checklist for Autism in Toddlers) Get Form MSHSL Sports Qualifying Physical Exam Resources & Forms Get Form Medical Records Release Get Form New Patient Intake Form Get Form Nexplanon® After-Placement Care Information Get Form Nexplanon® Information Sheet Get Form Nexplanon® Insertion Consent Form Get Form Nexplanon® Removal Consent Form Get Form Notice of Privacy Practices Get Form PHQ-9M – Patient Health Questionnaire Get Form Patient Portal Enrollment Form Get Form Patient Portal Frequently Asked Questions (FAQ) Get Form Patient Portal Terms of Service Get Form Temporary Consent to Treat Get Form Vanderbilt Assessment Scales for ADHD Evaluation by a Parent Get Form Vanderbilt Assessment Scales for ADHD Evaluation by a Teacher Get Form Select type... Locations Chaska (952) 448-3847 Location & Hours Delano (763) 230-2780 Location & Hours Maple Grove (763) 324-8000 Location & Hours Minnetonka (952) 473-0211 Location & Hours Save time. Book online! Book Now Locations Chaska (952) 448-3847 Location & Hours Delano (763) 230-2780 Location & Hours Maple Grove (763) 324-8000 Location & Hours Minnetonka (952) 473-0211 Location & Hours Spring Park (952) 495-8910 Location & Hours Save time. Book online! Book Now