Financial Policy

Thank you for choosing Michigan Pain Specialists, PLLC as your health care provider.  The following is our Financial Policy.  If you have any questions or concerns about our payment policies please do not hesitate to ask our business office.

Patient’s portion of payment, as well as any past due balances,  are due at the time services are rendered unless prior arrangements have been made with the billing department.  We accept cash, personal checks, and all major credit cards for payment.

We accept assignment with most major insurance companies and participating provider plans (Blue Cross/Blue Shield, Medicare, Aetna, Care Choices, Preferred Choices, Health Alliance Plan).  However, you must understand that:

We accept assignment with most major insurance companies and participating provider plans (Blue Cross/Blue Shield, Medicare, Aetna, Care Choices, Preferred Choices, Health Alliance Plan).  However, you must understand that:

1. Your insurance policy is a contract between you, your employer, and the insurance company.  We are NOT a party to that contract.  Our relationship is with you, not your insurance carrier.

2. All charges are your responsibility whether your insurance company pays or not.

3. Fees for services, along with unpaid deductibles and co-payments are due at the time of treatment.

4. If the insurance company does not pay your balance in full within 30 days we ask that you contact the carrier to request prompt payment.  Please inform our office of the carrier’s response.

5. Returned checks will be subject to a $25.00 collection charge.

6. Balances over 90 days may be charged a handling fee.

7. Unpaid balances over 60 days are subject to collections via small claims court, attorney, and/or collection agency with applicable collection fees.

8. Failure to cancel an appointment may result in a cancellation fee/No show fee charge of $50.00 for new patients and $25.00 for return patients.

We understand that temporary financial problems may affect timely payment of your balance.  We encourage you to communicate any such problems so that we can assist you in the management of your account.

Authorization to Release and Assign Insurance Benefits:  I authorize release of any information required to act on any insurance claim and permit photographic or other facsimile reproduction of this authorization to be used in place of the original assignment.  I here by assign to Michigan Pain Specialists, PLLC the medical and/or surgical benefits I am entitled from my insurance company and/or Medicare.

This authorization is in effect for all future claims, until I choose to revoke it in writing.

I, the undersigned, understand and agree to the above Financial Policy.  I understand that I am financially responsible for all charges incurred for my medical treatment.