Thank you for choosing us as your primary provider. We are committed to providing you with quality and affordable health care. Because some of our patients have had questions regarding patient and insurance responsibility for services rendered, we have been advised to develop a payment policy. Please read it, ask us any questions you may have, and sign in the space provided. A copy will be provided to you upon request.

Insurance: We participate in most insurance plans. If you are not insured by a plan we participate in, payment in full is expected at each visit. If you are insured by a plan we participate in but don’t have an up-to-date insurance card, payment in full for each visit is required until we verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any question you may have regarding your coverage.

Co-payment and deductibles: All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. Please help us in upholding the law by paying your co-payment at each visit. Please note that failure to pay your copay, deductible, or any past due balance at time of visit may result in your appointment being rescheduled, and possible release from our practice. If for some reason you feel you will not be able to meet this obligation, you may contact our Billing Office to discuss the possibility of a payment arrangement.

Non-covered services: Please be aware that some (and perhaps all) of the services you receive may be non-covered or not considered reasonable or necessary by your insurers. You must pay for these services in full at the time of the visit.

Proof of insurance: All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your driver’s license and current valid insurance to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of the claim. Please note that failure to supply us with proof of current/active insurance may result in rescheduling of your appointment. Fraudulent presentation of insurance coverage will result in immediate dismissal from our group.

Claims submission: If we are in-network with your insurance, we will submit your claims and assist you in any way we reasonably can to help get your claims paid. If we are out-of-network with your insurance, then you must pay for visit at time of service. Once we enter the charge, we will send you a bill along with a receipt that you will need to submit to your insurance to receive reimbursement. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not a party to that contract.

Coverage changes: If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim in 45 days, the balance will automatically be billed to you.

Nonpayment: If your account is over 90 days past due, you will receive a letter stating that you have 20 days to pay your account in full. Partial payments will not be accepted unless otherwise negotiated by the billing department. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you may be discharged from this practice. If this is to occur, you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During that 30 day period, our physician will only be able to treat you on an emergency basis.

Late arrivals: We attempt to schedule our patient as efficiently as possible to reduce your waiting time in our reception area. If you arrive for your appointment more that 15 minutes late, we do reserve the right to reschedule your appointment for another day and time.

Missed appointments: We politely request at least 24 hours notice. As a courtesy, we attempt to contact our patients to remind them of their appointments; however, it is the responsibility of the patient to arrive for their appointment on time. After three missed or broken appointment we reserve the right to politely ask you to receive medical care at another office. If you are a new patient, we will only allow you to miss or break your appointment with our office once. After that we are unable to provide medical care to you. We ask that you please try to understand our position on this delicate situation and kindly confirm your reserved appointment with our office no later than 24 hours before your appointment.

Workman’s Compensation: Please be aware that OB/GYN Care may release information to Workman’s Compensation Board.

Requests for Medical Records & Disability Forms: Please allow at least ten (10) business days for completion of disability forms and copies of medical records.

We must receive your completed Authorization for Release of Medical Records form in order to release your records.

Termination from our Practice: Our office values the relationships that have been established with our patient’s and wants to protect patients’ rights. We will only terminate patient relationships with cause and after careful consideration. Reasons for termination may include, but are not limited to:

Repeatedly not showing for scheduled appointments Not complying with recommended medical care Hostile or abusive behavior toward/with our staff
Not paying bills in a timely manner

We accept the following methods of payment: CASH, CHECKS, VISA, MASTERCARD & DISCOVER. Returned checks are subject to a $35 service fee.

Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area.

Thank you for understanding our payment policy. Please let us know if you have any questions or concerns.