I understand that I am financially responsible for all charges whether covered or not by my medical insurance carrier. It is my responsibility to find out what services are covered.
Copayments are due at the time of service and further appointments will NOT be scheduled if there is a balance on your account.
A late fee of $5 per month will be applied to outstanding bills over 60 days.
Hawaii residents are responsible for paying the general excise tax.
In the event you are unable to pay your bill within 60 days of the invoice a payment plan can be arranged by contacting us at 808-500-7077 or firstname.lastname@example.org.
If we have been unable to obtain payment in full or maintain scheduled payment arrangements from you after 120 days of repeated attempts, the account will be sent to a collection agency and you may be discharged from the practice.