Thank you for choosing our services. We are committed to providing you with quality and affordable health care. Please review this financial policy statement, ask us any questions you may have, and sign in the space provided. A copy will be provided to you upon request.
1. Insurance. We participate in numerous insurance plans and are pleased to assist you in receiving the maximum allowable benefits; however, having a knowledge of your insurance benefits is your responsibility. Your medical benefits are a contract between you and your insurer; if you have questions about your coverage for recommended vaccinations, office testing, or procedures, please contact your insurance company for payment details. If we do not participate in your medical insurance plan or you do not have an up-to-date insurance card, full payment is required at the time of your visit. We participate in numerous insurance plans and are pleased to assist you in receiving the maximum allowable benefits; however, . Your medical benefits are a contract between you and your insurer; if you have questions about your coverage for recommended vaccinations, office testing, or procedures, please contact your insurance company for payment details. If we do not participate in your medical insurance plan or you do not have an up-to-date insurance card, full payment is required at the time of your visit.
2. Proof of insurance.All patients (or their legal guardian, if the patient is a minor) must complete a patient registration form and allow us to copy a driver's license and current valid insurance card. Electronic confirmation of insurance eligibility is required at every office visit prior to seeing a physician. It is your responsibility to update us with any changes in your insurance coverage at the time of your visit.
3. Co-payments.All co-payments 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 co-payments from patients may be considered fraud. We accept cash, checks, VISA and master card. Returned checks are subject to additional collection fees.
4. Claims submission.If we participate with your insurance company, we will submit your claims and assist you, within reason, to help obtain proper payment. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Within several weeks of your office visit, you should receive an "Explanation of Benefits" (EOB) from your insurer outlining the details of payment for a specific date of service. The EOB is used by our Billing Service to determine what portion of a claim is assigned to your responsibility by the insurer. Depending on the details of your insurance plan, you may be responsible for the following: recommended vaccines, "in-office" testing or procedures, deductibles and co-insurances, as well as certain types of non-covered office visits.
5. Account Balance. A portion of each office claim may be assigned to you by your insurance. Please refer to your EOB to verify this balance. Once a statement is sent to you by our Billing Service, your account must be paid in full within 30 days.
6. Past-Due Accounts.Balances not paid within 30 days of an initial statement are considered "past-due." Each "past-due" statement, issued monthly, will incur a ten dollar processing fee which will be cumulative (a 10.00 dollar fee at 30 days will increase to $30.00 dollars at 90 days ). Families with past-due accounts will not be seen. At 90 days from the time of the initial statement, unpaid balances will be forwarded to a collection agency.
7. Deductibles. For plans with a yearly deductible, office claims will first be submitted to your insurance. Once assigned to "patient responsibility" by your insurance, you will receive a statement regarding the account balance due. Payment is required within 30 days.
8. 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.
9. Non-covered services.Please be aware that some of the services you receive may be considered non-covered by your insurance. You must pay for these services in full at the time of visit.
10. Self–Pay patients. All patients who do not have medical insurance and patients without a valid insurance card are considered self-pay. All self-pay patients are responsible for full payment at the time of the visit.
11. Missed appointments.A charge of $25.00 will be applied to any missed appointment (one for which we did not receive at least 24 hour's notice to cancel). This charge is your responsibility and will be billed directly to you. Please help us to serve you better by keeping your scheduled appointments. This fee must be paid in full by the time of your next scheduled office visit.
12. Late appointments.A patient who arrives late for their appointment is afforded a 15 minute "grace period." After this time, due to our busy office schedule, a late patient may not be able to be seen. Late appointments arriving beyond 15 minutes will be considered a "no-show" and are subject to the missed appointment fee.
13. Collection Agency and Bad Debt.Our practice will charge an additional administrative fee for all delinquent patient balances. Past due accounts that are turned over to a collection agency will incur an additional administrative fee. (see policy number six)
14. Prescriptions. Please bring a list of all your current medications detailing the strength, dose, and frequency or the bottles at each visit. All routine prescriptions will be filled within 48 hours. We do not fax prescriptions to mail-order pharmacies.
15. Fee for Forms. There is a $5.00 charge for all forms (physical, school, daycare) not presented at the time of a physical. All forms require 48 hours notice. Our office requires 7 days for letters of medical necessity due to their complex nature.
16. Transfer of records. There is $30.00 charge for transfer of medical records. All outstanding balances must be paid in FULL prior to transfer.
If you have questions about your insurance, our Business Office will help you. However, specific coverage issues should be directed to your insurance company's Member Services Department (the phone number is on your insurance card). Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area.
Our financial policy is subject to change at any time without notice.
Thank you for understanding our payment policy. Please let us know if you have any questions or concerns.