Thank you for choosing us as your health care provider. WE are committed to providing you with the best possible care. Your clear understanding of our financial policy is important to our professional relationship. Please understand that payment of your bill is considered part of your treatment and expected at the time of service. We accept Cash, Check, Visa, MasterCard and Discover.
Your insurance is a contract between you, your employer and the insurance company. We are not a party to that contract. While filing of insurance claims is a courtesy we extend, ALL CHARGES ARE YOUR RESPONSIBILITY FROM THE DATE SERVICE IS RENDERED. Not all services are a covered benefit in all contracts. The “Usual and Customary Charges: that may be quoted by your insurance company are charges that have been determined and set by your insurance company. They do not necessarily reflect our charges. Our fees are considered to fall within the acceptable range of most companies. Reduction or rejection of your claim by your insurance company does not relieve you of your financial obligation.
Any returned checks are subject to a $25 service fee. Any returned check must be resolved before any future appointments can be arranged. In the event we are forced to submit a delinquent account to a collection agency, there will be an additional fee added to your balance.
Thank you for understanding our financial policy. Please let us know if you have any questions or concerns.
I have read and understand the financial policy for the practice and I agree to be bound by its terms. I also understand and agree that such terms may be amended from time to time by the practice.