FINANCIAL AND INSURANCE POLICY
You are financially responsible for the services we provide to you. We understand that many patients arrange for insurance companies to pay for a large portion of medical claims. However, the patient (or legal guardian if the patient is a child) is ultimately responsible for the bill if the insurance company does not pay.
As a courtesy to you, we will file a claim to your primary and secondary insurance plans. We expect payment of all co-payments and payment for services not covered by insurance plans at the time of service. Should you be unable to make your co-payment at the time of service, we will work with you to reschedule your appointment. If you have more than two insurance plans, we will be glad to provide you with the forms you need to file a claim with a third or fourth insurance plan. Any balance remaining after insurance has paid their part of the covered portion will be due upon receipt of a bill (e.g. coinsurance, deductible, non-covered, etc.).
Our practice accepts Medicare patients. We will bill your secondary insurance if you provide us the proper insurance information. You are responsible for the applicable coinsurance and deductibles, and charges for non-covered services. In addition to the bill we send, you should also receive an explanation from Medicare indicating how much you owe.
Our practice accepts Medicaid patients for specialist treatment by referral only. A current Medicaid card must be presented at each visit, and you will be required to pay the co-pay at the time of service. If you have exceeded the legislative limits for the year as set forth by Medicaid, you will be held responsible for the charges. If you have “Carolina Access,” please be sure to bring your referral from your primary care physician.
Private Insurance Patients
Our practice accepts assignment for most major insurance providers. You will be required to pay applicable co-payments at the time of service, and you are responsible for any coinsurance, deductibles, and payments for non-covered services.
If our practice participates with your insurance, you will be required to pay the applicable co-payment at the time of service. When required by your HMO plan, you are responsible for obtaining a referral from your primary care physician. If you do not have a proper referral, you may be required to reschedule your appointment. If services are rendered without a valid referral authorization, you will be expected to sign a waiver and will be responsible for payment.
If you are involved in an accident, we will be pleased to provide medical care for you. In most cases, however, we do not file claims with third-party liability insurance plans. We will either file the claim with your medical insurance or we will expect a deposit and payments from you for all balances incurred.
Patients Without Insurance
Our practice is pleased to provide services to patients that do not have insurance. However, if you do not have insurance you will be expected to pay your bill in full at the time of service. We will be happy to quote the amount that will be due prior to your appointment so you may plan financially for this visit.
METHODS OF PAYMENT
We accept cash, check, VISA and MasterCard and American Express. We do not accept post-dated checks, nor will we hold checks for any length of time.
CANCELLATION AND RESCHEDULING
We make every effort to schedule appointments at a time that is convenient for you. If you need to cancel and/or reschedule an appointment, we require at least 24 hours’ notice. Patients who cancel or reschedule appointments with less than 24 hours’ notice, or are no-shows for a scheduled appointment, will be charged a $75 fee.
There will be a $35 fee assessed for any and all checks returned from the bank for any reason.
For all services rendered to patients who are minors, the adult accompanying the patient is responsible for payment. If the parents are divorced, the parent who accompanies the child to the doctor is responsible for payment, regardless of the terms of the custodial agreement.
Patients with an outstanding balance will be asked to pay this balance in addition to any co-payments and/or co-insurance due prior to being seen. If the balance cannot be paid in full, then we may consider monthly payment arrangements.
Please advise us promptly of any changes to your address, phone number or insurance carrier.
Members of our billing department are always available to help you with questions and/or payment arrangements. Once made in writing, agreements are binding. We consider payment by the patient for services rendered to be an important part of the patient’s role in the patient/physician relationship.
Prompt payment for services rendered is expected and failure to comply or respond to repeated communications from our office may result in discharge from the practice and involvement of an outside collection agency. Once an account has been referred to an outside agency, prior balances must be resolved before being seen by a physician.
Phone: (336) 585-1212
Fax: (336) 585-1112
M-Th: 8 a.m. - 4:30 p.m.
F: 8 a.m. - 12:30 p.m.
2921 Crouse Lane
Burlington, NC 27215