The following is a statement of our Financial Policy, which we require you to read carefully and sign prior to any treatment.
• All patients are on a cash basis until their insurance coverage and deductible may be verified by our staff.
• We reserve special times for you that other patients could be seen at. If you need to cancel or reschedule an appointment, please do so 24 hours in advance so that your scheduled time may be taken by someone else in need. Otherwise you will be charged with a Missed Appointment Fee of $25.00.
• A fee of $25.00 will apply to all returned checks.
• We accept assignment with your insurance company as a courtesy to you; you are responsible for your entire bill should your insurance company not pay any of the anticipated charges for any reason. We are not a mediator between you and your insurance company and will not enter into any dispute with the same, as your contract is between you and your insurance company.
• If you should receive a check from your insurance company during our billing, you must bring it into the office upon receipt. If an over-payment exists after all insurance billing has been done, we will issue an over-payment check to you- it will not come from your insurance company. All insurance payments regardless of which company issues a check first, are applied to your account as long as any balance is due.
• Any service not covered or coverage reductions by your insurance will be your responsibility.
• This office will bill your insurance ONE TIME. We will not enter into any dispute with your insurance company. If coverage problems arise, you will be expected to assist directly in dealing with your insurance company, adjuster, or agent. Any denied or disputed claims will be treated as uncovered services and you will be expected to pay such charges on a timely basis.
• Payment is due in full at time of service unless other arrangements are made. Thank You!