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Practice Payment Policy and Patient Obligations


Thank you for choosing us as your healthcare care provider.


We are committed to providing you with quality and affordable health care.

____ 1. Insurance. We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. We also offer a “Self-Pay Fee Schedule”, please refer to that form for details. It is important that you understand that knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage. It is your responsibility to provide the practice accurate and up-to-date insurance card information every time prior to your visit. You must inform the practice if another designated person is authorized to handle your financial matters, e.g. MPOA; the office will not discuss your specific case with any other person.

____ 2. Co-payments and deductibles. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your co-payment at each visit.

____ 3. Non-covered services. Please be aware that some – and perhaps all – of the services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit. It is your obligation to pay all charges unpaid by your insurance carrier or policy. This applies in particular to any and all services rendered by the practice under its “concierge services, special and/or signature programs”.

____ 4. Proof of insurance. All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim. It is your obligation to provide accurate and all necessary contact information required to properly process your claims and billing. Again, any misinformation that leads to delay and/or denial of claim will be the sole responsibility of the patient.

____ 5. Claims submission. We will submit your claims and assist you in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract. You may be contacted or receive billing and/or claims related notice or calls from our billing management and/or office. It is important that you respond to those inquiries as necessary. You may be contacted by our office, Athenahealth, and/or FocusOne; these two entities are contracted by the practice for billing and practice management.

____ 6. Coverage changes. If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim, the balance will automatically be billed to you.

____ 7. Nonpayment. If your account is past due, you may receive a letter stating that you have to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency.

____ 8. Missed appointments. Our policy is to charge for missed appointments not canceled within a reasonable amount of time. These charges will be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment.

Our practice is committed to providing the best treatment to our patients.

Thank you for understanding our payment policy. Please let us know if you have any questions or concerns.