Please Read Carefully
It is our policy that following a preliminary exam, any services which are rendered by this office on the initial visit shall be paid in full at that time, unless other arrangements have been made in writing.
Our office is pleased to accept your insurance assignment, as soon as your exact coverage is verified by the responsible party. However, it must be fully understood that the contract is between you and your insurance company, and you are fully responsible for any and all amounts not paid by your insurance.
Our office policy is as follows:
1. Since by taking your insurance assignment, we have to await payment, this courtesy may be withdrawn if warranted.
2. The deductible amount must be paid in full prior to billing.
3. Insurance payments should be made every 30 days. The maximum time limit we extend is 60 days, then fees must be paid in full by the patient.
4. You are required to sign "Authorization to Pay Physician" form and any other documents required by your insurance company.
5. Our office will not guarantee that your insurance company will pay. At the beginning of your healthcare, we will make every attempt to receive verification of your policy coverage. However, if for any reason your claim is denied, you are responsible for the total amount due this office.
6. This office will not enter into a dispute with your insurance company over your claim. This is your responsibility and obligation. We will, however, assist you in any way that we can.
7. You the patient must keep current with your insurance co-payment.
8. A 1.5% finance charge will be added to all accounts over 90 days old.
9. In the event that your account is past due, it may be turned over to a collection agency. If our account is not paid in full and this account is turned over to a collection agency and/or attorney, then you agree to be responsible for all reasonable fees necessary for the collection agency fees of 50% of the balance due and costs and reasonable attorney's fees of 33% of the balance.
10. If the insurance company sends you payment for our services, it is your responsibility and obligation to bring to us payment in full.