If you fail to notify our office of any address change and we are unable to locate you, we intend to turn over your account to a collection agency immediately.
You will be mailed an initial statement requesting payment. To keep your account current and open you must pay immediately or make payments as arranged in our payment plan. If we do not receive any response, we will attempt to send to you a second statement (past due) requesting payment. If we still receive no satisfactory response, we will attempt to send to you a final notice letter requesting payment within 15 days will be mailed. This will typically be our final attempt prior to being referred to a collection agency.
If at any time, you fail to adhere to your payment arrangements, or you do not respond in a way we deem cooperative to our collection efforts, your account may be assigned to a collection agency. If your account is ever referred to a collection agency, you will no longer be treated by the physicians until specific payment arrangements have been made. You will then be placed on a cash only basis. All fees for services must he paid at the time of service. You hereby acknowledge that our policy is appropriate and represents good faith by us.
"Fully Pay" as used in this document means payment to our office in full according to our office's regular billed rates and terms. You agree, whether you sign as agent or as patient, that in consideration of the services to be rendered to the patient, payment in full is due after services are rendered and upon billing. You agree to promptly Fully Pay our office.
Patients whose insurance requires lab to be performed at a certain lab must inform the receptionist or nurse at the time of the service. If we are not informed, you will be responsible for the charges incurred. All lab specimens collected at our office are processed at Columbus Community. Hospital unless other specific arrangements have been made at the time of service.
I consent to you and your agents and independent contractors using for appointment, billing, debt collection and any other purposes any wireless/cell phone numbers and email addresses I provide to you. This includes automated calls, pre-recorded/artificial voice messages, and all other calls, texts and emails. If I discontinue use of any phone number provided, I shall promptly notify you; I hereby indemnify you and your agents and independent contractors from any expenses or other loss arising from any failure to notify.
Our Office's Conduct:
Our office will attempt to code claims for your services and handle them as follows: If your insurance company has a contract with us, we will endeavor to file or otherwise handle claims as allowed by that contract. If your insurance company has no contract with us, we will endeavor to file insurance claims as a courtesy; however, you understand that this does not relieve you of your financial obligation to pay any portion that is not paid by insurance for any remson, such as but not limited to amounts deemed uncovered by the company or a company evaluation unacceptable to us.