Aurorafac.com - Patient Financial Policy and Direct Billing

Your understanding of our financial policies is an essential element of your care and treatment. If you have any questions, please discuss them with our front office staff or manager.

Payment for services and/or devices are due at the time of service. We will accept VISA, MasterCard, American Express, debit or cash. Personal cheques are not accepted.There are certain elective procedures for which we require pre-payment. You will be informed in advance if your procedure is one of those.For the initial pair of custom orthotics, there is a minimum deposit of 50% of the full purchase cost required at the time of order. For additional pairs, the entire balance is collected at order.ORTHOTICS ARE NOT REFUNDABLE. As prescription orthotics are custom-made for each patient, they cannot be returned for refund.Used medical devices, like splints or braces, cannot be returned for refund unless the product is deemed defective, in which a replacement device may be issued.A No Show/Cancellation fee may be charged for any missed appointment or cancellation made with less than 24 hour notice. Payment for visit fee(s), new or follow-up, are also nonrefundable.

MSP of BC

Podiatry is NOT a covered service of Medical Services Plan of BC. Posted fees for services or procedures are exclusive of any MSP reimbursement and are your responsibility to pay.Patients who have MSP Premium Assistance may have a subsidy towards appointment fees. MSP will be billed directly by the practitioner for any applicable services or procedures. Any MSP reimbursements will be paid directly to Dr. R J Stanford dba Aurora Foot & Ankle Clinic, Practitioner #52796. You will not be charged the portion that is reimbursable by MSP.

Private/Extended Medical Insurance

We DO NOT have direct billing access to private medical insurance providers. Therefore, all charges for your care and treatment are due at the time of service. At the time of payment, we provide a receipt which may be used for submission to private insurance. Our rates are the same regardless of insurance coverage or lack thereof. If your extended insurer requires so, you are responsible for all authorizations/referrals needed to seek treatment in this office.

Do We Direct Bill?

Yes! We offer direct billing for some podiatry services (like visits and procedures) to MOST private health insurance companies. However, some insurers still don’t allow podiatrists to direct bill on behalf of their patient. Please see the list below for current participating providers… but don’t hesitate to ask the receptionists if you don’t see yours.

Direct Billing is a courtesy we offer to our patients to help them with recovering the cost associated with visiting a Podiatrist in BC. All insurance plans are different, and in general, these terms of reimbursement were set up by your employer. It is our policy to not adjust our fees to match an individual’s plan as our fees are standard for all patients whether they have insurance or not.

Please note that due to privacy regulations, insurance companies do not allow us to see the coverage details of our patient’s plans, so we are not able to run pre-authorizations. Therefore, IT IS THE RESPONSIBILITY OF THE PATIENT TO KNOW THEIR COVERAGE DETAILS before attending an appointment or committing to purchase any medical device from our clinic.

Who Can We Direct Bill?

Pacific Blue Cross
Canada Life / PSHCP
Desjardins
Manion
RWAM

Medavie Blue Cross
ClaimSecure
GroupHealth
Manulife
Simply Benefits

Greenshield / SSQ
Coughlin
GroupSource
People Corp
Telus Adjudicare

Patient Name:*

First NameMiddle NameLast Name

Policy Holder Full Name:*

First NameMiddle NameLast Name

Insurance Company:*

Policy #:*

Certificate # / ID:*

At this time, we CANNOT direct bill any secondary plans. Therefore, if applicable, patients are responsible to submit any patient paid portion to their secondary insurance carriers.

I am aware of the policy and terms as outlined on this form and give consent for Aurora Foot and Ankle Clinic to bill my private insurance carrier on my behalf.

Patient Signature: *

Date:*

Date

Should you have questions before your next appointment, please don’t hesitate to give us a call, we would be happy to assist.

AURORA FOOT & ANKLE CLINIC INSURANCE POLICY & ACCOUNT INFORMATION FORM

Insurance Information – Primary Account only: