Family First Physicians is committed to providing quality medical services to our patients and clearly defining our financial policy. If you have any questions, please ask for a billing staff member for assistance.

1. Insurance: If we are billing your insurance, it is extremely important that you furnish us with accurate and updated information so your claim can be filed. We realize that during your care, changes can occur in your insurance policy or you may have additional information, such as secondary insurance that may also need to be billed. In order for us to do our job effectively and meet your needs, please make sure to provide our office with all the information and changes. Please understand that if you do have multiple insurances, you MUST inform us of all policies. This will ensure that your file has the most up-to-date information possible.

**Please be aware that if you have an AHCCCS plan, it is ALWAYS the payer of last resort. Any other health insurance plan must be billed prior to AHCCCS. This means that if you do not provide our office with your primary insurance information, AHCCCS will not pay.

2. Proof of Insurance: We will bill your insurance with the information you provide us, at time of service. Failure to provide us with the correct information could result in the denial of your claim. If this occurs, you assume responsibility for the entire amount of the claim.

3. Non-Covered Services: All health plans are not the same and they do not always cover the same service. Please be aware that some of the services you receive may be determined "not covered" by your health plan. You must pay for these services in full within ninety (90) days. If you have questions as to what services are covered, contact member services (the number is listed on your insurance card.) It is your responsibility to be aware of your benefits, we do not quote or verify benefits.

4. Claims and statements: A claim for services will be submitted to your insurance within 45 days of your visit. You should receive an explanation of benefits (EOB) from your insurance company explaining what they paid. As a courtesy, our office will send three (3) monthly statements to the responsible party for any balance remaining. If payment in full is not made within 31 days of the first statement date, a $25 late fee will be applied. If you have questions about your bill or feel you received the bill in error, please contact our Billing Department as soon as possible to avoid any fees.

5.Types of Payments: Our offices accepts cash, check, money order, VISA and MasterCard. Any check returned to our office by the bank will be subject to an additional $25 service fee and our office will no longer accept payments via personal check.

6. Responsible Party: The person signing these forms agrees to be listed as the Guarantor and accepts sole financial responsibility for services rendered by Family First Physicians.

 

I agree to pay all finance charges, late fees, collection costs, attorney fees, and any other costs that may be incurred to enforce collection of any amount outstanding.

I have read, understand and agree to the financial policy stated above and accept responsibility for all payment of all fees/charges incurred with Family First Physicians.