Financial Policy

Financial Policy

Shere’e Edwards

HCR 230

January 16, 2010

Professor Bosede Olaogun-Muftau

Financial Policy

Financial Policy

To reduce any misunderstanding or confusion between our patients and the practice we have developed a summary of our financial policy. We are dedicated to the success of your medical treatment and service to you. Please consider your complete understanding of your responsibilities as a vital part of your care and treatment. Please carefully evaluate the following information and return to us with your signature and today’s date. If you need any further information regarding any of these policies, please ask to speak with our office manager.

All Payments

Co-payments are due at the front desk prior seeing the physician unless other arrangements have been made in advance with you or your insurance carrier. We accept payment by cash, checks, VISA, MasterCard, American Express and Discover. There is a $ 25.00 service charge on any returned checks payable by cash. Thereafter, you will be placed on a “cash only” basis to pay for your services.

Insurance

We accept most major insurance companies; however, please contact our office or your insurance company to see if a referral from your primary care doctor is needed. To help reduce paperwork and relieve patients of financial burdens, we have entered into contractual agreements with most insurance and third parties and filed as a courtesy to you. It is the patient responsibility to provide current insurance information at time of service. If the information is not current it is the responsibility of the patient to pay in full of the service rendered until the current insurance information is provided.

Referrals

If your plan requires that you need a referral authorization for your visit we will request the authorization from your primary physician before your visit. Your appointment will be rescheduled if we are unable to attain the referral.

No Insurance

Payment is due in time...