Financial & Insurance Information

Statements/Payments: You might have a balance on your account after insurance processes, if so we will send you a statement. Once you receive a statement, you will have 30 days to pay the balance in full, if not, the balance will become past due. If the balance is not paid in full, a service charge of 1.5% per month will be applied. Our office policy does not allow partial payments. Balances must be paid in full with one payment.

Insurance: Insurance is a contract between you and your insurance company. We are not a party to this contract, in most cases. We will submit claims to your insurance company as a courtesy to you. We will expect payment in full from you if your insurance company delays processing of your claim for over 60 days. You agree to pay any portion of the charges not covered by insurance. Please remember, you or your employer choose your contract benefits.

If your insurance company requires a referral and/or preauthorization, you are responsible for obtaining it. Failure to obtain the referral and/or preauthorization may result in a lower payment from the insurance company.

Custodial Matters: It is our policy that we bill the custodial parent for all health care services. In cases where a written court order allows payment for medical costs associated with a dependent, it is the responsibility of the custodial parent to obtain reimbursement from the other party involved.

Payment Options

NO INSURANCE

1.  Full payment on the day of service, with cash, check, or a credit card (VISA, MasterCard or Discover)  You will be charged for any returned checks.

2.  Health Care Financing/No Payment Day of Service (Upon approval)

                  *Please notify our office prior to your appointment for application information if needed.

INSURANCE

1.  Due on the day of service is a minimum of 30% or the percent that you are responsible to pay based on your current insurance benefits. This will go towards co-payments, deductibles, etc., with the balance due in full within 30 days after insurance has processed. The clinic will file your insurance for you. You will be responsible for all non-covered services after the claim has processed. (*Defer 30% payment with Health Care Financing, option 2, above)