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Office Financial Policy
If you have insurance, please bring you insurance card with you. We will bill your insurance. Co-payment and any deductible are due at the time of your visit. Any amount, except the preferred provider discount, not paid by your insurance company will be billed to you for payment.
Please provide your primary insurance information. Please note for most plans we will bill your primary insurance only. If you have Medicare and a supplemental insurance plan, please provide your supplemental insurance card at the time of the visit and we will bill it for you. If you do not provide supplemental information at the time of your visit you will be responsible for the balance due after Medicare pays.
Our office accepts Visa, MasterCard, American Express and Discover Card.
There are over 1000 insurance plans in America; therefore, it is impossible for our office to know the covered benefits of your insurance plan. It is the responsibility of the patient to know and understand the policies and benefits of his/her insurance. This includes:
- required referrals obtained and presented prior to service being rendered
- co-payments to be made at the time of service
- covered hospital/laboratory/x-ray procedures
- prior authorization procedures
- current claim address
I request payment of authorized insurance benefits be made to this office for any services furnished to me or on my behalf. I authorize any holder of medical information about me to release to my insurance company and its agents any information needed to determine these benefits or the benefits payable to related services.
The patient is ultimately responsible for all professional fees.
If you do not keep your scheduled appointment or if you cancel with less than 24 hours notice you may be charged a fee.
Fees for missed appointments or less that 24 hour cancellation are as follows:
- $25.00 – office visit
- $50.00 – office visit with hearing test
- $75.00 – office surgery
- $75.00 – allergy testing
* Please note – 24 hour cancellation notice applies to regular business hours Monday through Friday.