Financial Policy

*In order to reduce confusion and misunderstanding between our patients and the office, we have
adopted the following financial policy. If you have any questions, please discuss them with one
of our patient account representatives. We are dedicated to providing the best possible care to
you and regard your complete understanding of our financial policies as an essential element of
your care and treatment.

*Payment is due at the time of service unless other arrangements have been made in advance.
For your convenience, we accept cash, check, Mastercard and Visa credit cards.

*Your insurance is an agreement between you and your insurance company. As a courtesy to
you, we will file your insurance claims for you if you assign benefits to the physician. If your
insurance company does not pay within a reasonable period, we will look to you for payment. If
we later receive a check from your insurer, we will refund any over payment to you.

*All health plans are not the same and do not cover the same services. In the event your health
plan determines a service to be “not covered”, you will be responsible for the complete charge.
Payment is due upon receipt of a statement from our office. We highly recommend that you
READ YOUR INSURANCE BOOKLET or a copy of the contract your policy falls under to
determine your benefits.

*You will be responsible for promptly responding to your insurance company to provide any
additional information they may request regarding your treatment, pre-existing conditions,
accidents or other insurance coverage. Failure to respond in a timely manner may result in your
account becoming due and payable, in full, immediately.

*Be prepared to present your insurance card and proof of identity (e.g. driver’s license) at each
visit. You will be responsible for providing a change of address, telephone number and/or
insurance information anytime a change occurs.

*A prepayment of your deductible and coinsurance will be required for your portion of our
fees, based on our contract allowables, for scheduled surgical procedures. Any balance
remaining, after your health plan pays, is your responsibility. Payment is due upon receipt of a
statement from our office.

*We will look to the adult accompanying a minor for payment of all services rendered to minor
patients.