Thank you for entrusting your primary care to us. We are dedicated to providing you with the best possible health care. Our professional relationship depends on your awareness of our Patient Financial Policy. Please keep in mind that paying for services is an essential element of the partnership. Your responsibility is to notify our office of any patient information changes (i.e., name, address, telephone, insurance information, etc.) Please ask concerning our charges, policies, or your responsibilities if you have any questions.
Insurance: Most insurance plans, including Medicare, are accepted. If you are not covered by one of our plans, you must pay in full at each appointment. If you are covered by one of the plans we work with but don’t have an up-to-date insurance card, you must pay in full for each appointment if we can’t verify your coverage. You must understand your insurance benefits. Please contact your insurer if you have any question about your coverage.
Services that are not covered: Please keep in mind that some – if not all – of the benefits you receive may be non-covered or not considered necessary by Medicare or other insurers. You have to pay for these services in their entirety at the time of your visit.
Deductibles and co-payments: All co-payments and deductibles must be paid at the time of service. Your insurance company has agreed to this arrangement as part of your contract. Our failure to collect co-payments and deductibles from patients may constitute fraud. Please contribute to the enforcement of the law by paying your co-payment at each visit. We take Visa, Mastercard, and American Express, money orders, cash, and checks are all accepted to make payments more convenient. A returned check fee of $35 will be added to your account in addition to the inadequate funds. Following any returned check, you may be placed on a cash-only basis.
Proof of Insurance: Before seeing the provider, all patients must fill out our patient information form. To offer evidence of insurance, we’ll need a copy of your driver’s license/ ID and current valid insurance. You may be held liable for the balance of a claim if you fail to provide us with accurate insurance information in time.
Submission of claims: We will submit your claims and assist you in any way we can to get your claims paid as quickly as possible. Your insurance company may need you to provide certain information personally. It is your responsibility to follow their instructions. Whether or not your insurance provider covers your claim, your responsibility is the rest of your claim.
Coverage changes: If your insurance changes, please let us know before your next visit so that we can make the necessary adjustments to ensure you get the most out of your coverage. If your insurance carrier does not settle your claim within 45 days, you will be billed for the amount.
Nonpayment: Our office policy is to send two statements to all past due accounts. If no payment received, a single phone call would be made to try to negotiate payment arrangements on the account. If a settlement cannot be reached, the account will be submitted to a collection agency and may be discharged from the practice. You will be alerted via regular and certified mail that you have 30 days to find other medical care if this happens. Our physician will only be able to treat you in an emergency during those 30 days.
Self-Pay Accounts: Patients without insurance coverage, patients covered by insurance plans in which the office does not participate, and patients without an insurance card on file are all considered self-pay accounts. Attorney letters and contingency payments are not accepted. It is always the patient’s responsibility to determine whether or not our office is a participant in their plan. If there is a disparity with the information provided, the patient will be considered self-pay unless otherwise demonstrated. Our goal is to provide the best care and the least amount of stress to our patients.
Minors: The billing statements will be sent to the parent(s) or guardian(s) responsible for full payment. Unaccompanied minors may be required to bring a signed authorization by a parent/ guardian to treat.
If you are above 18 years of age and undergoing treatment, you are ultimately responsible for payment of the service, regardless of any personal arrangements you may have outside of our office. Our office will bill no other individual. Our practice is dedicated to providing our patients with the best possible care. Our pricing is typical of what you’d expect to pay in our neighborhood.
This clinic may charge a $25 fee for no-show appointments. If I do not cancel the appointment, I am liable for paying the price.