FINANCIAL POLICY
Payment: Payment in full for your estimated insurance co-payment is due at the time of your visit. Please be prepared to pay. We accept the following forms of payment: Cash, Check, Debit, Visa, MasterCard, Discover, and American Express
In order to control the cost of billing, we request payment at the time of service, as well as payment of any outstanding balances. Statements will be mailed to your address. Please pay your bill upon receipt. Repeat billing is costly and should not have to occur. Should we have to send more than one billing statement for the same balance, a $5 repeat billing fee will be added for each additional statement.
Insurance: Our office is committed to helping out patients maximize their benefits. Your insurance policy is a contract between you and your insurance company. As a medical provider, we are not party to that agreement. We require our patient(s) to provide us with their up-to-date medical insurance; without this we are unable to estimate coverage for a patient. Failure to provide us with your current medical insurance will result in your payment in full for services rendered. Understand that prior verification of insurance coverage is only estimation and never a guarantee of payment per the insurance company. Copays, coinsurance and deductibles are due at the time of service.
Missed appointment Policy : Our office requires a 24-hour notice to cancel or reschedule an appointment. The Fee for missed appointments or rescheduling same day appointments, without a 24-hour notice is $35.00, which must be paid in full prior to your next appointment. We understand unforeseen circumstances may occur. Please understand that your missed appointment hinders our ability to effectively care for you and prevents us from caring for another patient as an appointment slot has been taken up by you.
Returned Checks: You will be responsible for a $50 service fee if your bank returns your check for insufficient funds.
Records Request: Fee for copying records is $1.00 per page
Medication Refills: Medications are refilled during your visit with the doctor. Please do not call our office for refills. If you need a medication refill, please have your pharmacy send in an e-refill request or request your refill through the Healow App or our Patient Portal. By doing so, the request automatically populates in your medical chart. We do not refill medication if the doctor has not seen you within 1 year or less based on your health risks. Requests are handled within 72 hours. For your safety, the doctor will review each request before authorization. WE NO LONGER ACCEPT FAXED REFILLS REQUESTS.
Referrals: Physician must initiate referrals during your visit. Prior notification of at least 48 hours is required for established consultation follow-ups. Same day faxed requests are no longer accepted.
Forms: All forms must be presented to the Receptionist. Completion of most medical forms requires a FEE. If you want the form mailed to you, please provide a self-addressed envelope. Please allow 5 to 7 working days for completion.