Our Financial Policy
Thank you for choosing us as your healthcare provider. We are committed to the success of your treatment. Please understand that payment of your bill is considered a part of your treatment. The following is a statement of our Financial Policy, which we require you to read and sign prior to any treatment.
Information and Insurance Form:
All patients must complete our Information and Insurance form before seeing the doctor.
Payment:
Full payment is due at the time of service. We accept cash, checks, debit, or credit cards.
Regarding Insurance:
We may accept assignment of insurance benefits. However, we do require the portion responsible by the patient to be paid at the time of service. The balance is your responsibility, whether your insurance company pays or not. We cannot bill your insurance company unless you provide us with your insurance information at the time of the visit. We do not bill retroactively. If your insurance company has not paid the balance in full within 45 days, the balance will automatically be your responsibility and expected to be paid in full. Please be aware that some or all of the services provided may be non-covered services and not considered reasonable and necessary under the Medicare Program and/or other medical insurance.
Insurance Plans where we are a Participating Provider:
All co-pays and deductibles are due prior to treatment. In the event that your insurance coverage changes to a plan where we are not participating, refer to the above paragraph.
Usual and Customary Rates:
Our practice is committed to providing the best treatment for our patients, and we charge what are usual and customary rates.
Adult Patients:
Adult patients are responsible for full payment at the time of service.
Minor Patients:
The parents or guardians accompanying the minor are responsible for full payment. For unaccompanied minors, non-emergency treatment will be denied unless charges have been pre-paid.
Missed Appointments:
Unless canceled at least 24 hours in advance, our policy is to charge $35.00 for missed appointments and $75.00 for missed physical appointments. Please help us serve you better by keeping your scheduled appointments.
Thank you for understanding our Financial Policy. Please let us know if you have any questions or concerns.
I have read the Financial Policy. I understand and agree to this Financial Policy.