Payment Policy
Thank you for choosing us as your primary care providers. We are committed to providing you with quality and affordable health care. Because some of our patients have had questions regarding patient and insurance responsibility for services rendered, we have developed this payment policy. Please read it and ask us any questions you may have. A copy will be provided to you upon request.
1. Insurance. We participate in many insurance plans, including Medicare. We do not participate with Medicaid. If you are not insured by a plan with which we participate, payment in full is expected at each visit. If you are insured by a plan with which we do participate, but don’t have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. Your insurance benefit is a contract between you and your insurance company, and knowing your benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.
2. Co-payments and deductibles. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company.
3. Non-covered services. Please be aware that some – and perhaps all – of the 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.
4. Proof of insurance. All patients must complete our Patient Information form before seeing the doctor. We must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.
5. 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. Any unpaid claims older than 45 days are your responsibility to pay upon receipt of the bill. Remember, your insurance benefits are a contract between you and your insurance company.
6. Coverage changes. If your insurance changes, please notify us immediately so we can make the appropriate changes to help you receive your maximum benefits.
7. Nonpayment. If your account with us is over 90 (ninety) days past due, you will receive a letter stating that you have 10 (ten) days to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you and your immediate family members may be discharged from this practice. If this were to occur, you would be notified by regular and certified mail that you have 30 (thirty) days to find alternative medical care. During that 30-day period, our physicians will only be able to treat you on an emergency basis.
8. Missed appointments.
Our policy is to charge only for repeated missed appointments not cancelled within
24 hours of the appointment time. These charges will be your responsibility and billed
directly to you. Please help us to serve you better by keeping your regularly
scheduled appointments.
This payment policy is subject to change without notice.
(6/6/04)