Clinic Payment Policy
Thank you for choosing us as your provider. We are committed to providing you with quality and affordable health care. Some of our patients have had questions regarding patient and insurance responsibility for services rendered, so we have developed this payment policy. Please read it, ask us any questions you may have, and sign in the space provided. A copy will be provided to you upon request.
- Insurance. We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured by a plan we do business with, but don’t have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. It is your responsibility to call and confirm if we are in network with your insurance. Please contact your insurance company with any questions you may have regarding your coverage.
- Co-payments and deductibles. All co-payments and deductibles must be paid at the time of service for office visits and before any surgical procedures. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients could nullify the contractual obligation. Please help us in upholding the contractual obligation by paying your co-payment at each visit.
- Non-covered services. Please be aware that some – and perhaps all – of the services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit.
- Proof of insurance. All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your driver’s license and current valid insurance card to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.
- Claims submission. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.
Notice of Privacy Practices
This notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please download and read the seven-page printable version.