you for choosing us as your health care provider. We are committed to
providing you with the best possible care and to your treatment being
successful. Your clear understanding of our financial policy is important
to our professional relationship. Please understand that payment of your
bill is considered part of your treatment. We accept CASH, CHECK, VISA,
MASTERCARD, and DISCOVER.
Our practice is committed to providing the best treatment for our patients. We must emphasize that as a Medical Care provider, our relationship is with you, our patient, not with your insurance company. We cannot accept the responsibility of negotiating the claims with insurance companies or any other persons. While the filing of insurance claims is a "Courtesy" that we extend to our patients, all charges are your responsibility from the date of the services rendered.
Your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract. It is very important that you understand the provisions of your policy. We cannot guarantee payment of all claims. If your insurance company pays only a portion of the bill, or rejects your claims, any contact or explanation should be made to you, their policyholder. Reduction or rejection of your claim by your insurance company does not relieve you of your financial obligation.
Not all services are a covered benefit in all contracts. Some insurance companies arbitrarily select certain services they will not cover. Some and perhaps all of the services may be considered "Non-Covered" services and not considered necessary under Medicare and other medical insurance programs. Please remember that professional services are rendered and charged to the patient, not the insurance company.
We charge what is usual and customary for our area. The patient is responsible for payment in full within a reasonable time - regardless of the status of the claim or any insurance company's arbitrary determination of usual and customary rates. Our fees are considered to fall within the acceptable range of most companies and therefore are covered up to the maximum allowance determined by each carrier.
If you have a managed care medical insurance that we particpate with, your payment of deductibles, non-covered services and co-payments are due when services are rendered. If we do not participate with your insurance company or if you do not have health insurance coverage, payment for services is due at the time services are rendered.
Although an insurance claim is filed, you will receive a statement of your account has a balance due after a period of 45 days. This office cannot accept responsibility for collecting your insurance claim or for negotiating a settlement of a disputed claim. The patient is responsible for payment of the account within the limits of our credit policy. We realize that temporary financial problems may affect timely payment of your account. If such problems do arise, or in circumstances where a claim is pending or when treatment will be for an extended period of time, it is recommended that a payment plan be initiated. We encourage you to contact our office manager for assistance in the management of your account.
Any returned checks are subject to a $25.00 service fee. Any returned check must be resolved before any future appointments can be arranged.
Any account in which collection actions are pursued will be responsible for the collection fee. This fee will be 35% of the total balance due at the time the account has been turned over to the collection agency.
Minor Age Patients
For unaccompanied minors, non-emergency treatment will be denied unless charges have been pre-authorized prior to the date of service. The adult accompanying a minor and the parents or guardians are responsible for payment in full. (This includes minor patients of divorced/separated parents, the adult accompanying the minor patient will be responsible for payment in full.)
Medicare, Medicaid, and Worker's Compensation
If you are covered by one of the above, or any other government sponsored program, please discuss your payment situation with our billing staff prior to the date of treatment. You must present your "current months" medical card prior to services being rendered. If your card is not available, we will be happy to reschedule your appointment. If you are a Medicare patient, you will be responsible for notifying us of your deductible status. If you have not met your deductible, you will be responsible for paying it at the time services are rendered. If you do not have a supplement policy, you will be responsible for your 20% of the Medicare allowable fee (or if you are Medicaid Spin-down). All Medicare patients will be required to pay for the Refraction fee at the time of service. If you are a Medicaid patient, and have a co-payment, you will be required to pay the fee at the time of service.
Thank you for understanding our financial policy. Please let us know if you have any questions, or concerns.