Financial Policy

Our Financial Policy

We appreciate your trust in us and we appreciate the opportunity to serve you.  As you may know our office takes great efforts to get insurance companies to pay their share in a timely manner.  Often insurance companies inexplicably delay payment to the doctor and, despite you’re paying increased premiums year after year, they non-negotiably reduce reimbursement payments to us.  In order to stay in business, we often find ourselves having to make some hard decisions. As a result, we have updated our Financial Policy, which we require that you read, agree to and sign prior to any treatment.


All new patients are to pay prior to services for their first visit regardless of insurance coverage.


You must present your insurance card at the time of your visit. If we do not have your insurance card on file, you will be responsible for that day’s services. If you did not update your insurance information at the time of your visit, you will be responsible for that day’s services. We will provide you with an itemized receipt that you can file with your insurance. As a reminder, we bill your insurance as a courtesy to you but if you do not provide us with the insurance information at the time of service, you are responsible for the balance. We will not bill insurance for past services.

We make no claim to know what services your insurance covers.  While we make a good faith attempt to verify coverage, we are not able to guarantee that the information given to us by your insurance is correct.  It is your responsibility alone to know what insurance plan you are on, supply us with the correct information at the time of your visit and know what services may or may not be covered by your insurance.  We encourage you to refer to your benefits manual if you have any questions about covered services.  Be aware that some and perhaps all of the services provided may be not covered by your insurance.  You will be responsible for payment of all non-covered services at the time they are rendered.


If your policy requires a primary care physician referral, prior approval or other pre-authorization in order for you to receive services, it is your responsibility to see that the necessary referral is current and any necessary prior approval or pre-authorization has been presented to our office prior to receiving services. If no required referral, prior approval or other pre-authorization is present in advance, you will be personally responsible to pay for any services rendered to you. We will use our best efforts to assist you in obtaining the necessary referrals, approvals and pre-authorizations.


Regarding insurance, your insurance policy is a contract between you and your insurance company.  We are not a party to that contract.  We require certain co-payments, deductible or prepayment amounts depending on the type of insurance or insurance carrier.  Be assured our office works diligently to obtain payment from you insurance company.  However, if we file your insurance and the claim has not been paid for any reason within 60 days, we require that you pay the balance using one of the approved payment methods without exception. In the event that your insurance pays us after that time, you will be reimbursed.


Our office will not submit claims to your insurance for non-covered services.


Partial payments will not be accepted unless otherwise negotiated with our billing office. Past due accounts are subject to collection proceedings and are reported to the collection bureau.  Unpaid balances over 90 days will be referred to a collection agency and/or small claims court. All collection fees and court fees shall become the patient/guarantor’s responsibility in addition to the balance due the office.


Medical records request and forms completed outside of an office visit are subject to a fee. Medical record fees are $25.00 for the first 20 pages and $.50 for each page thereafter. Medical forms completed are $25.00 up to $45.00 depending on complexity.


Please give us at least 24 working hour’s notification if you cannot keep an appointment.  This courtesy will allow others to be seen.


Our bank charges us whenever a patient presents a check that does not have funds available.  Therefore, we must charge you a $30.00 handling fee.  All future visits will need to be paid with either cash or credit card (not debit card). No exceptions.


We will issue patient refunds by check within 30 days of a completed investigation of the potential overpayment, as long as other outstanding account balances have been resolved.

We welcome the opportunity to discuss any aspect of our financial policy.  Please ask to see our office manager if you have any questions, comments or concerns.  We sincerely regret having to maintain such a policy and hope you understand our reasoning. This authorization shall remain valid until and unless revoked by either party in writing and may be updated at any time without notice.  We thank you for your support and look forward to serving you in the future.