Patient Financial Responsibilities
• The patient (or patient’s guardian, if a minor) is ultimately responsible for the payment for his/her treatment and care.
• We are pleased to assist you by billing for our contracted insurers. However, the patient is required to provide us with the most correct and updated information about their insurance, and will be responsible for any charges incurred if the information provided is not correct or updated.
• Patients are responsible for the payment of co-pays, co-insurance, deductibles, and all other procedures or treatment not covered by your insurance plan. Payment is due at the time of service, and for your convenience, we accept cash, debit, and most major credit cards at our office.
• Patients may incur, and are responsible for the payment of additional charges at the discretion of The Doctor Is In. These charges may include (but are not limited to):
Charge for returned checks - $50.
Charge for missed appointments without 24 hours advance notice - $30
Charge for the copying and distribution of patient medical records.
Charge for extensive forms completion.
Any costs associated with collection of patient balances.
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