1. All co-payments are due at the time of the visit. This arrangement is part of your contract with your Insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered a violation of the contract you have with your insurance company. Our office accepts cash, credit, and debit cards, no checks.
2. Co-insurance and unmet deductibles are the patient's responsibility. Once benefits are verified and your financial responsibility calculated, you will be notified of the payment amount. If you are unclear of your benefits please contact your insurance prior to your visit. Your insurance carrier's phone number is usually on the back of your insurance card.
3. You are ultimately responsible for payment of charges for services you receive from our office.
4. In accordance with your insurance member handbook, it is your responsibility to provide accurate insurance information and to present your insurance ID card at the time of your visit. If you do not have insurance or do not present a valid insurance card, you will be responsible for payment at the time of service.
5. If your plan requires a referral, it is your responsibility to obtain this prior to being seen by our provider.
6. A scheduled appointment means that time has been reserved for you. Cancellations for appointments must be received at least 24 hours prior to the scheduled appointment.
7. It is the policy of this office to charge a $25.00 missed appointment fee for all appointments that are not cancelled with a minimum of 24 hour's notice. This fee will automatically be billed to your account. This fee is not covered by any Insurance Carrier, Medicare, or Medicaid, and is the sole responsibility of the patient.
8. Administrative Services: There is a $50.00 charge for each required Administrative Service, payable prior to service completion. This Administrative Service Fee covers specific administrative services such as forms completion for family medical leave and disability, letters for insurance authorizations for a brand or non-formulary drugs, letters for employers, school, health clubs, and any other administrative items not covered by insurance.
9. SELF-PAY: Payment in full is due at the time of service if you do not have health insurance.