It is our sincere desire to provide the best of medical care to our patients. To continue to do this, we must be adequately compensated. Therefore, to avoid any misunderstanding and allow you to be prepared, we are providing the following information to you. Please read the information provided here. Your signature will be required at the office to acknowledge your understanding.
We do expect payment at the time of service. If your insurance policy is one with which we have a contract to accept co-pay only, we will do so. We will file a claim to your insurance for the balance. Your signature below assigns benefits to us from your insurance.
Your signature also authorizes us to release medical information to your insurance company if necessary to secure payment.
If needed, please do not hesitate to speak with us regarding a payment plan. We will be happy to work with you.
Billing Statements: Patient statements are mailed the last week of each month. If you have a portion due, we will mail a statement to you. You should not receive a statement if we are awaiting payment from your insurance for the total balance. Therefore, if you do receive a statement, please open it and provide payment to us.
REFERRAL AUTHORIZATION NUMBERS: IF YOUR INSURANCE COMPANY REQUIRES THAT YOU OBTAIN A REFERRAL NUMBER FROM YOUR PRIMARY CARE PROVIDER PRIOR TO SEEING A SPECIALIST, YOU ARE RESPONSIBLE FOR DOING SO. YOU ARE ALSO RESPONSIBLE FOR KEEPING TRACK OF ANY EXPIRATION DATES FOR THE REFERRAL NUMBER AND CONTACTING YOUR PRIMARY CARE PROVIDER TO UPDATE THE AUTHORIZATION.
Any questions or concerns you may have are important to us. We do appreciate you reading this financial policy.