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Financial Policy

Thank you for your expression of confidence by choosing our office for your medical care. We promise to work hard at making your experience here as satisfying as possible. Part of our relationship will involve the fees for the care we provide. We have developed the following Financial Policy to detail our expectations and reduce any confusion between us.

Regarding Patients with Insurance Coverage

Insurance is a financial agreement between the insured and the insurance company. As a courtesy, our staff will file your claim with your primary insurance carrier without charge. We expect that you will pay your portion of the bill (co-payments and deductibles) at the time of each service. Please remember that should your insurance company fail to pay your bill for service within 60 days, the entire balance will become your responsibility. Should any payment by your insurance company result in an overpayment, we will make a refund as appropriate.

Regarding Non-Medical Fees

We also require FULL payment for items such as medical record copies, completion of special forms and letters, and the processing of disability statements. These items are not covered by insurance. Please feel free to ask any questions that you may have regarding this policy or how it may relate to your individual situation or insurance company.

Disability Forms

We are happy to fill out disability and FMLA paperwork for you. You must bring the paperwork in to the office so that you can sign a medical release of information as well as pay the fee for the paperwork ($20.00). The charge is for each form we receive. For example, if you have a FMLA form and a disability form, the total would be $40.00. Once you have filled out your paperwork and paid the fee, you will receive a date 10 business days from the day you are dropping off your paperwork. Your forms will be done by this date and mailed to you. Due to the number of forms we get, unfortunately, we are unable to fax or mail them to the company. They are mailed directly to the patient.

Also, we do not take disability forms via fax nor do we talk to disability companies over the phone. You must have your company mail the forms to you and bring them in for completion. If we do receive forms via fax, we will call you and let you know that we have received them and you may come in and fill out a medical release of information and pay for the forms. We will not forward the forms to our disability completion team until you have signed and paid. You again will receive a date 10 days from the drop off date that the paperwork will be done.

If you are having surgery or will be taking personal leave for any medical reason for more than 3 days, you should contact your Human Resource representative and inquire about your employer/disability forms in order to get them completed in a timely manner. The sooner we get your paperwork, the sooner we can get it back to you so that you do not have an interruption in pay.

If you have any questions, please do not hesitate to ask a staff member.

Disclosure of Protected Health Information