Please bring all pertinent insurance information and your insurance cards with you on each visit to our office. Also we recommend that you bring your preferred method of payment ( credit card, check or cash) to pay for deductibles or co-pays. Your co-pay or deductible must be paid at the time of service.
Our office files your insurance as a courtesy. We recommend that you should review and understand your insurance policy. Your insurance policy is a contract between you and your insurance company. It is not a contract between you and our Doctors.
Should your insurance carrier withhold payment or partial payment of your claim for any reason, we will be glad to assist you in obtaining an explanation from them. However, we cannot guarantee payment of your claim. Also, we cannot be responsible for negotiating fees or claims with insurance companies or any other entity. Patients are responsible for payment of medical care within a reasonable time, regardless of the status of the claim.
If pre-authorization is needed, then it is your responsibility to notify our staff so we may obtain authorization. If no authorizations are on file we cannot provide the services unless you decide to pay for visit at self-pay rate. Patient balances are expected to be paid in full. We do not have payment plans for outstanding balances. Partial balance payments through the mail will not be accepted.
If you have any questions or are not prepared to pay for your appointment, please notify one of our staff prior to your appointment. If you are unable to pay for residual balances from previous dates of services, you may be asked to reschedule your appointment.
There is a $50.00 fee for missed appointments (unless a 24-hour notice is given) or more than 15min late arrival.
There is a $25.00 fee for returned checks.
There is a$ 25.00 for printing medical records (first 100 pages then additional 30cents/per page).
There is a placement fee of thirty dollars ($30.00) in addition to the balance subject to collection.
By my signature below I acknowledge that I agree with Payment Policies.
New Patients: New patients to our practice and patients following up from hospital can complete New Patient Paperwork prior to appointment. We welcome new patients for consultations. You may contact us directly or through a referring physician.Please make sure to forward copies of your medical records from other physicians before your first appointment, which will be set for the earliest time and date possible.
Please print the New Patient Packet supplied and bring the completed forms with you to our office. Please arrive approximately 15 minutes early to allow for parking and timely arrival.
Prior to your appointment: On your first appointment and all future appointments, please bring a list of all medicines you are presently taking (include all herbal and over the counter medication), photo ID and your health insurance card(s) and method of payment for co-pays/deductibles.
Pharmacy: Please call your pharmacy to see if the prescription has been filled prior to calling the office and call pharmacy directly for refills. For refills: pharmacy will fax the request to our office and it will be reviewed immediately. We cannot refill if you are not a current patient or have not come for follow up in more than one year. Prescriptions will not be filled on weekends/holidays or after 5:00pm Monday - Friday.
Referrals: If a referral has been made to another physician and you do not hear from that
physician's office within 2-3 days, please contact our office so that we can assist you in getting your appointment scheduled.
Laboratory Testing: Many times your physician will ask that you have "fasting" blood work. The definition of fasting is: nothing after midnight except water or medications. When the doctor orders blood work, please have it done no less than 1 week prior to your next appointment so that your lab results can be discussed with you when you come in.
After hours: Bringing your concerns to our attention during office hours will ensure the problem
is dealt with sooner and a prompt follow-up is scheduled. For urgent matters, you should go to the Emergency Department for any medical emergencies.
Change of information: If you have any changes on your name, address, phone number or insurance, please notify us as soon as possible. We do not want such changes to affect your medical care.
Out of network: If your insurance plan is out of network:
We will have to collect full payment at time of service. After service we will send a claim to insurance and insurance will notify you how much of what you payed will be covered or not.