-The information below
explains our Financial Policy. Please
understand that payment of your bill is part of your treatment.
-All patients should provide
accurate and complete personal and insurance information prior to being seen by
the doctor.
-All applicable co-pays,
co-insurances, personal balances, both current and prior are due at the time of
service.
-We will do our best to
answer any questions; however, ultimately it is your responsibility to be
informed about your personal policy. Specific insurance questions are best answered by your insurance
company, and can be contacted at the number on your insurance card.
What Is My Financial Responsibility for Services?
Your financial responsibility depends on a variety of factors, explained below:
| If you have… | Your responsibility… | Our office will… | |||
| Commercial Insurance | Doctor co-pay amount, out | File your insurance | |||
| (BCBS, Pref. One, etc.) | of pocket % or $ amount applied | claim as a courtesy | |||
| to deductible is due at the time | to you, as well as any | ||||
| of service. | claims to a secondary | ||||
| policy. | |||||
| Medicare | If you have Regular Medicare | File your claim with | |||
| as primary, and also have a | Medicare and your | ||||
| secondary insurance, no payment | Supplement Insurance. | ||||
| at the time of the visit for | |||||
| services allowed by Medicare. | |||||
| Medicaid | All co-pays are due at the time | File your claim with | |||
| of service, as are any non- | Medicaid. | ||||
| covered service fees. | |||||
| Work Injury | No payment is required at the | Work with the Auto | |||
| Automobile Injury | time of service providing Motor | Insurance carrier or | |||
| Vehicle/Work Comp insurance | Work Comp to | ||||
| is provided at the time of service. | identify financial | ||||
| *We’ll need the auto insurance | liability and file your | ||||
| policy or Work Comp information. | claims with them. | ||||
| No Insurance | 50% down payment on the services | Establish an affordable | |||
| provided is required at the time | payment plan that fits | ||||
| of service. | your budget. Recommend | ||||
| using Care Credit. | |||||
We
accept payment by cash, check, VISA, Mastercard and CareCredit.
Every courtesy will be taken on our part to work with you in deciding a payment plan to satisfy your account. If, however, no regular payment plan is upheld and your account goes past due 120 days, it will be referred to a collection agency.
For checks returned to us as unpaid by your bank, we will charge a returned check fee of $35.00.
We are happy to process, copy and mail your digital x-rays per your request after receiving your signed request accompanied by a $15.00 processing fee.