5. Regarding Insurance We participate with Medicare and most insurance plans. However, you must realize that your insurance is a contract between you, the insurance company, and/or your employer. While we may be a provider of services, we are not a party to the contract. It is imperative that complete personal information and a copy of your current insurance card is provided prior to being seen to ensure accurate billing. PLEASE NOTE: If incorrect insurance information is given by the patient or patients guarantor, any denial or unpaid claim will be the financial responsibility of the patient.
Some insurance companies arbitrarily select certain services they will not cover or which they may consider medically unnecessary. In these instances, you will be responsible for these amounts. Some Policies have deductibles for surgical procedures. The insurance companies consider procedures like cryosurgery (freezing with liquid nitrogen), removal of moles, or other small procedures as "surgery". If you have a surgical deductible that has not been met and have one of these procedures, you will be responsible for payment at the time of service. Please be aware that any amount collected from you at the time of service is just an estimate. Final patient responsibility is determined by your insurance carrier and you will be billed for any responsibility left to you by your insurance carrier less any payments made by you towards your visit.
6. Missed Appointments Please help us to serve you better by keeping scheduled appointments. Appointments must be canceled at least 24 hours in advance. Please be aware that if you no-show for your appointment, or cancel your appointment within 24 hours of your scheduled appointment, you will be charged a $50.00 fee.
7. PAYMENT DUE Be advised that we require payment in full within 90 days of the receipt of the explanation of benefits from your insurance company. Our practice does understand that medical bills at time can be burdensome. If you need more than 90 days to pay your balance you must contact our office to make a payment arrangement. You will be required to provide a credit/debit card that can be auto-drafted each month to secure payment. Any balance past 90 days due without a secured payment arrangement on file will be considered overdue and will be subject to collections. Please be advised that recurring payment arrangements are subject to approval and the length of duration is dependent on the amount owed. The maximum duration for any balance may not exceed 12 months.
8. Past Due Accounts Overdue accounts will be turned over to a collection agency. Please be aware that a $50.00 processing/filing fee, as well as a fee of 40% of your balance, will be added to your account. EXAMPLE: $200 owed + $50 processing + $80 (40%) = $330 will be your new account balance
-For checks returned to us as unpaid by your bank, we will charge a $45 fee.
I have read the Financial Policy. I understand and agree to the Financial Policy: