It is imperative that a current copy of your insurance card and a valid photo ID is provided for
accurate billing. It is extremely important for you to educate yourself about your individual
insurance benefits. Every patient’s insurance policy is different and it is beyond the ability of our
staff to know the benefits of every plan. Our office can never guarantee coverage for every
service provided by our office. If you are unsure of your coverage benefits, call the customer
service number on your insurance card.
INSURANCE: Our office participates with Medicare and many managed care insurance
companies. Should your insurance coverage be with one or more of these companies, we will bill
your insurance company within the guidelines of our contract. However, co-payments, coinsurances,
deductibles, and non-covered services that have not been satisfied, are the
responsibility of the patient and payment is expected at the time services are rendered. Copayments
not collected at the time of service will be assessed a $5.00 surcharge. Co-payments
and outstanding balances are collected at check-in. Doing so expedites your check out process
and also gives you the opportunity to consult with the business office if you have any questions.
Your PRIMARY INSURANCE will determine how services (including lab tests) will be
processed for coverage. We will file claims to your secondary insurance as a courtesy. You will
be responsible for providing timely payment for balance due for claims that are denied based on
Coordination of Benefits. Insurance information submitted to us past the timely filing date, will
be your full financial responsibility.
NON-PARTICIPATING INSURANCE: If you have an insurance that we do not participate
with, we ask that payment be made at the time services are rendered and your insurance company
will reimburse to you any amount due. As a courtesy to our patients, we will submit a claim to
your insurance company.
SELF-PAY PATIENTS: Payment for medical services is expected in full at the time services
are rendered. The practice will extend a 25% courtesy off our standard charges.
SELF-PAY PATIENTS: Payment for medical services is expected in full at the time services
are rendered. The practice will extend a 25% courtesy off our standard charges.
PAYMENT ARRANGMENTS: There are times when making a payment can be a financial
hardship. It may be necessary to set up a payment plan for a patient who cannot comply with our
financial policy. If you are in need of special payment arrangements, please advise our staff prior
to your visit. Co-pays are exempt from this because your insurance requires you to pay your copay
at the time services are rendered.
RETURNED CHECKS: Returned checks will be assessed a $30 returned check fees per check.
Incurring two (2) returned checks would permanently warrant a patient status of cash only. A
patient with a cash only status may pay with cash, credit card, money order or cashiers check.
REFERRALS: If your insurance plan requires a referral from your primary care physician
(PCP), in order to see one of our specialty providers, it is your responsibility to request and obtain
this referral from your PCP. Your physician may fax this referral to our office directly. However,
if we do not receive this referral prior to your scheduled visit, you will be responsible for payment
or you will need to reschedule your appointment. Please call our office 48 hours in advance of
your appointment, to verify that your referral has been received.
Financial Policy
Get Acrobat Reader
|