Our goal is to provide and maintain a good physician-patient relationship. Letting you know in advance of our office policy allows for a good flow of communication and enables us to achieve our goal. Please read each section carefully. If you have any questions, do not hesitate to ask a member of our staff.
Patient Responsibilities and ExpectationsPlease understand
It is your responsibility to keep us updated with your correct insurance information. If the insurance company you designate is incorrect, you will be responsible for payment of the visit and may have to submit the charges to the correct plan for reimbursement.
It is your responsibility to understand your benefit plan with regard to, for instance, covered services and participating laboratories. For example: some plans do not cover medical supplies the physician may deem medically necessary for your recovery. You would be personally responsible for payment of such services.
It is your responsibility to know if a written referral or authorization is required to see specialists, whether pre-authorization is required prior to a procedure, and what services are covered.
According to your insurance plan, you are responsible for any and all co-payments, deductibles, and co-insurances.
If our physicians do not participate in your insurance plan, payment in full is expected from you at the time of your office visit. For scheduled appointments, prior balances must be paid prior to the visit unless other arrangements have been made in advance.
In the case of a workers' compensation injury or automobile accident, you are responsible for obtaining the claim number, phone number, contact person, and name and address of the insurance carrier prior to your visit.
If you have no insurance, payment for an office visit is to be paid in full at the time of the visit.
Co-payments are due at time of service.
A $35 fee will be charged for any checks returned for insufficient funds, in addition to any bank fees incurred.
If we have to turn your account over to collection, you will be charged 33% collections fee on the outstanding balance and you will be responsible for all costs and expenses of collection including, but not limited to our reasonable attorneys' fees.
Please call us if you have a question about your bill. Most problems can be settled quickly and easily, and your call will prevent any misunderstandings. If you are having trouble paying you bill, please discuss the situation with us. Satisfactory arrangements can almost always be made. Financial considerations should never prevent children from receiving the care they need at the time they need it.