Thank you for choosing Beacon of Hope as your health care provider. We are committed to building a successful provider-patient relationship with you and your family. Your clear understanding of our Patient Financial Policy is important to our professional relationship. Please understand that payment for services is a part of that relationship. Please don't hesitate to ask if you have any questions about our fees, policies, or your responsibilities. You are responsible for notifying our office of any changes to patient information (e.g., address, name, insurance details).

Co-pays:
The patient is expected to present an insurance card at each visit. All co-payments and past-due balances are due at check-in unless you have made prior arrangements with a billing coordinator. Our practice cannot waive the co-pay, as your insurance carrier requires it. We accept cash, checks, or credit cards. We will not accept post-dated checks. Payments are also accepted by phone. Self-pay patients must pay at the time of service.

Outstanding Balance Policy:
Please bring all outstanding balances up to date within the first 30 days of receiving your statement. If you do not pay the account, we will place a hold on it, and you may not schedule appointments until the account is brought up to date.

Collections:
Our office policy is to send accounts 60 days past due to collections. If you do not pay, we will make a single phone call to arrange payment. If we cannot reach a resolution, we will send the account to collections.

Insurance Claims:
Insurance is a contract between you and your insurance company. Patients are responsible for verifying that the provider they are seeing is in network. We will bill your primary insurance company as a courtesy. To bill your insurance company properly, we require that you disclose all relevant insurance information, including primary and secondary insurance, as well as any changes to your insurance information. Failure to provide complete insurance information may result in the patient being responsible for the entire bill. Although we may estimate what your insurance company may pay, the insurance company makes the final determination of your eligibility and benefits. If your insurance company is not contracted with us, you agree to pay any portion of the charges not covered by insurance, including but not limited to those charges above the usual and customary allowance. If we are out of network for your insurance company and your insurance pays you directly, you are responsible for payment and agree to forward the payment to us immediately.

Fees:

• Cancellation Fee - You will not be charged a cancellation fee if you cancel your appointment 24 hours in advance.
• No-Show Fee - If you don't cancel 24 hours in advance and fail to appear for your scheduled follow-up appointment, you will be charged a No-Show Fee of $35.00. You will be charged a $50.00 no-show fee if you fail to appear for your new patient appointment. You can't be seen until you pay this charge.
• Late Fee - If you are more than 10 minutes late for your appointment, it will be at the office's discretion whether you will be seen. If you are seen, we will not charge a fee. If you are not seen, the No-Show Fee applies. You can't be seen until you pay this charge.
• Forms or Letters - A $50.00 fee applies for completing medical forms or letters, such as FMLA forms and letters for support animals. You pay this fee up front before we complete the form. In some instances, you may need to schedule an appointment, and your insurance will be billed.
• Medical Records - We charge a fee to request medical records, per State of Ohio guidelines. As the fee changes annually, please check with the front desk for the current charges.