Payment Policy:

• Any co-pay and/or coinsurance is due at the time of service.
• Any past-due balance must be paid prior to additional service.
• Should you need to discuss a payment arrangement, please contact our office prior to coming in for your appointment. 
• Accepted methods of payment are cash, personal check, money order, Visa, MasterCard and Discover.
• Delinquent accounts will be referred to a collection agency.

Credit Card Request:
Regardless of insurance coverage or method of payment, all patients are required to provide our office with Visa, Discover or MasterCard credit card information to keep on file. Medical claims will be filed to your insurance(s) prior to any balance statements being sent to you. No charges will be made against your credit card if your account balance is paid by another form of payment. No charges will be made against your credit card without a minimum 1 week notification by mail. Charges will be applied on or after the date indicated on the notification unless another form of payment is received prior to the date indicated. Failure or unwillingness to provide credit card information will require payment in full at the time of service.

Form Completion:
There is a fee for the completion of some forms.  Prepayment is required prior to completion. Please contact our office regarding specific charges.

Insurance:
We will file claims to your health insurance as long as we have obtained a valid copy of your insurance card(s)

Payment in full will be required at the time of service if insurance information is not provided or is incomplete.

Any balance not covered by insurance will become the patient’s responsibility.

Insurance coverage is based on a contract between you and your insurance company. Therefore, it is your responsibility to know and understand your policy requirements, including any prior authorization needed. Please contact your insurance company for questions regarding coverage and benefits.

Workers’ Compensation / Auto Insurance / Other Third Party Liability:
The following information must be provided at check-in. Failure to provide this information will require us to reschedule your appointment.

• Claim number
• Name and telephone number of claims adjuster
• Date of injury
• Responsible party (name, address, telephone number)
• Claim billing information (name, address, telephone number)
• Attorney information if applicable (name, address, telephone number)
• Commercial health insurance information