Patient Payment Policy
Thank you for choosing our practice! We are committed to providing you with quality and affordable health care. Some of our patients have had questions regarding patient and insurance responsibility for services rendered; we have developed this financial policy. Please read it, ask us any questions you may have and check the box provided. A copy will be provided to you on request.
Insurance: We participate in most insurance plans. We will bill your insurance company as a courtesy to you. Although we may estimate what your insurance company may pay, it is the insurance that makes the final determination of your eligibility.
Claims Submission: We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not a party to the contract.
Co-Payments and Deductibles: All copays must be paid at the time of service: this arrangement is part of your contract with your insurance company. Failure on our part to collect copays and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your copay at each visit.
Non-Covered Services: Please be aware that some and perhaps all of these services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of the visit.
Proof of Insurance: All patients must complete our information form before seeing the doctor. We must obtain a copy of your driver's license and current insurance card. If you fail to provide us with the correct insurance informationin a timely manner, you be responsible for the balance of the claim.
Coverage Changes: If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits.
Methods of Payments: We accept cash, check, Visa and Mastercard.
Patient Statements: Unless other arrangements are approved by us in writing the balance on your statement is due and payable when the statement is issued and is past due if not paid within thirty days; you also agree to pay attorney fees, court costs, collection fees and annum APR at the time of service.
Non Payment: If your account is past due you will receive a letter from us stating you have 10 days to pay your account in full. Please be aware that if a balance remains unpaid we may refer your account to a collection agency, if this is to occur you will not be seen in the office until your balance is paid in full and all charges for futre visits will be collected up front.
Returned Checks: There is a fee of $25.00 for any checks returned by the bank.
Divorce: In case of a divorce or separation, the party responsible for the account is the parent authorizing treatment for a child. If the divorce decree requires the other parent to pay all or part of the treatment costs, it is the authorizing parent's responsibility to collect from the other parent.
Worker's Compensation: We require written approval by your employer and/or worker's compensation carrier prior to your initial visit. If your claim is denied you will be responsible for payment.
Personal Injury: If you are being treated as part of a personal injury lawsuit or claim, we require verification from your attorney prior to your initial visit. Payment of the bill remains the patient's responsibility. Also, any forms on your behalf are also subject to be charged at your responsibility. We cannot bill your attorney for charges incurred due to a personal injury case.
No Insurance: Payment in full at the time of service.
Medicaid: All spend down accounts you will be responsible for your account after insurance has paid. You then will be billed by our office and that amount will be due.
Cancellation Policy: If you cancel your appointment the day of your scheduled appointment or fail to show for your appointment with out notification, you will be charged $25.00 out of pocket. We require 24 hour notice to cancel an appointment.