At Modern Foot and Ankle - A Division of Medical Group, we are committed to providing quality care and transparent communication regarding our financial policies. Please take a moment to review our payment responsibility policy to ensure a smooth billing and payment experience.

1. Insurance Information

• Insurance Coverage: It is the patient’s responsibility to provide accurate and up-to-date insurance information at the time of each visit. Failure to provide current information may result in denial of claims or delays in processing.
• Verification of Benefits: Our office will assist in verifying insurance benefits; however, this does not guarantee payment. Patients are responsible for understanding their insurance plan and any out-of-pocket obligations, including copayments, deductibles, and co-insurance.

2. Payment at Time of Service

• Copayments: All copayments are due at the time of service. This is a contractual agreement between the patient and their insurance carrier.
• Self-Pay Patients: For patients without insurance, payment is due in full at the time of service unless prior arrangements have been made.
• Non-Covered Services: If a service is not covered by the patient’s insurance, payment will be required at the time of the visit.

3. Outstanding Balances

• Statements: Statements will be sent for any remaining balance after insurance payments have been processed. Patients are expected to remit payment upon receipt.
• Payment Plans: If you are unable to pay your balance in full, please contact our billing office to discuss payment plan options.
• Delinquent Accounts: Balances over 90 days past due will be considered delinquent and may be subject to collection efforts. Delinquent accounts may incur additional fees for collection services.

4. Methods of Payment

• We accept the following forms of payment: cash, check, debit/credit cards, and Health Savings Account (HSA) or Flexible Spending Account (FSA) cards.
• A $25 fee will be charged for any returned checks.

5. Referrals and Authorizations

• It is the patient’s responsibility to obtain any required referrals or prior authorizations from their insurance company. If a referral or authorization is not obtained, the patient may be responsible for the full cost of the service.

6. Missed Appointments and Late Cancellations

• If you need to cancel or reschedule an appointment, please notify us at least 24 hours in advance. Failure to do so may result in a missed appointment fee of $50.

7. Worker’s Compensation and Motor Vehicle Accidents

• For claims related to worker’s compensation or motor vehicle accidents, patients must provide necessary information to process the claim. If claims are denied or not covered, the patient will be responsible for payment.

8. Financial Hardship

• We understand that unexpected financial hardships can arise. If you are experiencing difficulty in paying your medical bills, please contact our office to discuss possible financial assistance programs.

9. Legal Responsibility

• Ultimately, it is the patient’s responsibility to ensure that all charges for services rendered are paid in full. Failure to meet financial obligations may result in legal actions.

Contact Information

For any questions or concerns regarding your account or this payment policy, please contact our billing office at 314-396-9517 or support@mfa-stl.com.
By receiving services from Modern Foot and Ankle, you acknowledge that you have read and understand this Payment Responsibility Policy.
Effective Date: 06/01/2024
This policy is intended to clarify payment obligations and foster a respectful and transparent financial relationship between patients and our practice.