Financial Policy

If you are covered by health insurance, please provide your insurance information to the front office staff, and we will be happy to bill your insurance. Accepting your insurance information does not place any financial responsibilities onto this practice, and you will be held accountable for any unpaid balances.

Based on the limits of your insurance plan benefits, not all diagnostic tools and procedures performed by our practice may be considered inclusive with the office visit. You, the patient, would be financially responsible for any amount applied to your deductible, out-of-pocket expense, coinsurance amount or noninclusive amount. Copayments are collected at the time of service. Any other balances are due upon receipt of a statement from our office.

No-show appointments are subject to a $35 missed appointment fee.

Completing insurance forms, copying medical records, etc., requires office staff time and physician time away from patient care, so we require payment for completing forms or copying medical records. The charge is determined by the complexity of the form, letter or communication.

I authorize the release of medical or other information necessary to process insurance claims, and I authorize payment of the medical benefits directly to this practice for services rendered.