If you are not covered by a plan with which we have a contract, you must pay in full at each appointment. If we accept your insurance but you don’t have a current insurance card, you must pay in full for each appointment until we can confirm your coverage. You are responsible for understanding your insurance benefits, including deductibles, copayments, and contracted lab, radiology, and hospital facilities. Your insurance policy is a legal agreement between you and your insurer. That contract does not include us. If you have any questions about your coverage, please contact your insurance company. Any changes in your insurance coverage must be reported to our office.
Co-Payments, Deductibles & Co-Insurance
Payment of all copayments is required at the time of service. This arrangement is part of your contract with your insurance company. Failure to collect copayments on our part may be considered fraud. Patients with deductibles must pay 50% of the total amount payable at the time of service. If you have coinsurance, 5% of the total bill will be collected at the time of service.
Coverage varies by the health plan. Please be aware that your health plan may find that any of the treatments you get are “not covered.” These services must be paid in full.
Proof of Insurance:
We will bill your insurance on the information you provide us at the time of service. This requires us to copy your current insurance card and also require you to confirm your registration information. Your failure to provide us with the correct information could result in the denial of your claim. If this occurs, you assume responsibility for the entire amount of the claim.
We will file your claims and support you in every way we can to ensure that they are reimbursed. Your insurance provider may need you to personally provide certain information directly. If your insurance provider does not settle your claim within 60 days, you will be billed for the remaining balance.
Billing Statements & Statement Fees:
On a monthly basis, the patient’s balance statements are sent out. The initial statement is free of charge. A $5 statement / late charge will be applied to each subsequent statement for the same outstanding claim.
No Show / Late Cancellation Fees:
Missed appointments and appointments that are not canceled with at least 24 hours notice will be charged $25. These fees are your responsibility and will be billed to you directly. Please keep your booked appointment to help us better serve you.
Accounts that are overdue for more than 90 days and have not been addressed with our billing staff will be sent to collections. It’s possible that you and your immediate family will be removed from our practice.
On the initial visit to our clinic, a minor patient must be accompanied by a parent or legal guardian so that we can acquire a signature to treat the young patient. If we obtain written authorization, a child may be treated without the presence of a parent or guardian on subsequent appointments. At the time of service, the adult accompanying the child patient is liable for paying for the delivered treatment.
FMLA, Disability, and Forms $30
Patient Records $25 (Personal Copy)
Patient satisfaction is very important to us. Our pricing is typical of what you’d expect to pay in our neighborhood. Thank you for taking the time to go over our payment policy. If you have any questions or issues, please contact us.