Thank you for choosing us as your health care provider. We are committed to the success of your and/or your child’s treatment. Please understand that payment of your bill is considered part of your treatment.
FULL PAYMENT IS DUE AT THE TIME OF SERVICE.
WE ACCEPT CASH, CHECKS or VISA/MASTERCARD.
Although we have contracted with your insurance company to provide care to their clients, your insurance policy is a contract between you and your insurance company. All co-pays and deductibles are due prior to treatment, along with a valid referral from your primary care provider, if your insurance plan requires it. If you require treatment that is not deemed medically necessary or is not a covered service with your insurance carrier, you will be responsible for payment in full prior to the treatment. If your insurance coverage changes to a plan where we are not participating providers, you will be responsible for payment of the visit in full.
Certain procedures, such as the use of a microscope or endoscope, are necessary for the evaluation or management of your child’s condition. These procedures may or may not be covered under your office visit or copay. Some insurance companies require that these charges apply toward your deductible. You will be responsible for these additional charges.
Non-par provider and out of network
If we are not a participating provider with your insurance plan, you are responsible for payment of all charges incurred in our office. We will supply you with itemized forms you may use to submit to your insurance carrier for possible reimbursement. The charge incurred and balance on your account is your responsibility whether your insurance company pays or not. Please be aware that some, and perhaps all, of the services provided may be non-covered services and not considered reasonable and necessary and may not be reimbursed or paid for by your insurance carrier. In the event your child requires surgical procedures or diagnostic testing performed outside our office that requires an authorization form or referral, your insurance carrier may not cover these services since you are being treated by a non-participating provider. It is your responsibility to verify if your plan offers any type of out-of-network benefits.
We require your deductible and co-insurance be paid prior to the scheduled procedure unless other financial arrangements have been made. Payments for deductible and co-insurance must be paid 48 hours prior to the scheduled procedure to secure your surgery date and time.
The adult accompanying a minor and the parents (or guardians of the minor) are responsible for full payment. Unaccompanied minors cannot be seen for non-emergency treatment.
If your bank returns your unpaid check for any reason, such as insufficient funds or closed account, you will be charged $40.00. Payment must be made prior to your return to the office, and we may not accept personal checks going forward.
You may be dismissed from the practice if you fail to meet your financial responsibilities and/or we must use a collection agency to bring your account up to date. If it is necessary to turn the account over to collections and you wish to return to the practice, you will be responsible for all charges, including those incurred to collect the amount owed, i.e., collections agent’s fees. Your account must be paid in full before you are able to return to the office.