Financial Policy

1. The patient is responsible for payment, and payment is required at the time of service.
2. We accept cash, check, Visa or Mastercard.
3. If you have insurance coverage, you will be expected to pay a percent of the bill at the time of service (or copay, as appropriate).  You will also be held responsible for any additional charges not covered under your policy.  Should a credit balance occur, we will refund any overpayment promptly.
4. There will be a charge for all forms filled out, whether by the office staff or the primary care provider.
5. Appointments must be cancelled at least 24 hours proir to the appointment time to avoid charges to your account.  If your appointment is for a Monday, cancellation must be made on the preceding Friday.
6. Returned checks, and accounts with balances over 30 days old, may be subject to additional collection fees.
7. If you have any questions or concerns regarding these policies, please feel free to contact our bookkeeping staff.  They will assist you.
8. Any accounts with a balance past 180 days, will be turned to patient responsibility.

 

NOTICE TO MEDICARE AND HMO/PPO PATIENTS

 

Certain services provided by this office are considered non-covered by your insurance.  If one or more of these services is provided, you will be asked for payment for those services.

Our office does not mail or fax referrals to specialists' offices unless it is a medical emergency.

 

 

I understand and acknowledge the above financial policy.