This information is provided to inform you of our practice policy regarding financial obligations. If you have any questions or need clarification of any of these policies, please feel free to contact us.

Copays
The patient is expected to present an insurance card at each visit. All copayments and past balances are due and payable at the time of service. Our office accepts cash, checks, Visa, MasterCard and Discover Card.

Returned Checks
Checks returned from the bank for insufficient funds are subject to a $25.00 fee.

Unpaid Balances
Any unpaid balances on billings more than 30 days overdue are subject to a finance charge of 1.5% per month (18% annually).

Extended payment arrangements
For procedures where the patient responsibility is less than $300: 50% of the patient’s responsibility is to be paid at the time of the visit OR 50% of the surgical fee is to be paid prior to the procedure. The remaining balance is to be paid over the next three months in equal monthly payments due by the first of every month.

Self-pay accounts
Self pay accounts are patients who are covered by insurance plans that the clinic does not participate in, patients without an insurance card on file, or who at the time of service do not meet the deductible.  It is expected that payment be made at time of service for all services including surgeries.

Nonparticipating insurance plans
The financial obligations of patients who are insured by carriers that this practice does not participate with are considered a self-pay account.  The insurance company will be billed as a nonassigned claim as a courtesy to the patient, with the patient paying the clinic the full amount due. 

Divorce/Child custody cases
In cases of divorce, the individual who receives the care is responsible for payment of copays, coinsurance and deductibles at the time of service.  We will not bill the divorced spouse for the patient’s services.  Likewise, the clinic will not get involved in divorce specifics when providing care to children. It is the parents’ obligation to work out an agreement themselves or through the court system.  The clinic will bill the insurance company.

Allergy copays and balances
If you have a copay/coinsurance for your allergy shots or vials, we ask that you come prepared to pay that amount each week.