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New patients are required to complete patient information forms prior to seeing the physician. Established patients are required to update their information forms at least once a year. We will ask to see your insurance card and driver's license on every visit and will scan your card into our system as needed to keep our information current.
Copayment/Deductible
Your insurance requires that we collect your designated co-pay and/or deductible at the time of service. Please be prepared to pay the above fees at each visit.
Private Pay
Private pay accounts shall exist if a patient has no insurance coverage. For new patients, a payment of $250 - $500, dependent upon the anatomical site, is expected on the day of your appointment before treatment from your physician. Established patients will be required to make, and keep current, all payment arrangements specified in their individual payment plan.
Extended payment plans
Patients are encouraged to pay outstanding private-pay balances in full. However, payment plans may be accepted in rare cases with approval.
Out-of-network Insurance Plans
As a service to our patients, we will bill as a non-assigned claim. Any outstanding balances are the responsibility of the patient. We are in-network for most, but not all insurance plans, it is your responsibility to verify what your insurance plan will cover and that we are providers for your plan.
Referrals
If your Insurance Plan (Primary or Secondary) requires a referral from your Primary Care Physician it is YOUR responsibility to obtain it prior to your appointment and to have it with you at the time of the appointment. If you do not have your referral, you may be required to reschedule.
Workers Compensation
We do not handle workers compensation cases within the clinic. We encourage you to seek out another physician if you need workers comp assistance.
Medicare
We will submit to Medicare for the Medicare allowed amount. The patient will be responsible for the deductible and the co-insurance, which can be billed to a secondary insurance if applicable.
Returned Check Fees
Any returned check from the bank for non-payment (insufficient funds) shall result in the patient's account being assessed a $30 fee per check returned.
Delinquent accounts
Delinquent accounts may be assigned to a collection agency. All collection costs will be added to your outstanding balance.
Forms Completion/Medical Records Requests
From time to time various forms including but not limited to disability and FMLA forms will need to be filled out. There will be up to a $20 charge to complete these forms. There may be a nominal fee for photocopying or printing medical records in accordance with the state allowance.
We accept cash, MasterCard, Visa, Discover, American Express, debit cards, and checks.
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