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 Methods Of Payment
Our practice accepts the following methods of payment:
cash, personal checks, Master Card and Visa credit cards.
If a check reaches our bank and your account has insufficient funds to cover the check, a $25.00 service charge will be applied to your account. In this instance, you will be asked to pay by cash or credit card for all future visits with the practice.
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Filing with Health Insurance Companies
• You are required to present your insurance card at every visit. We must have a copy of your insurance card to file any insurance for you or your family.
• All insurance changes must be given to us at the time of service. If your insurance coverage changes and we are not notified, you will be responsible for all charges. We will be unable to bill your insurance for any prior charges before the change notification.
• Your insurance company requires our office to collect co-payments, deductibles, and coinsurance amounts at the time of service. If you are unable to make your payment according to the terms of your insurance policy at time of check-in, you will not be seen by the provider.
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Self-Pay Patients
Self-pay patients, or patients who pay the entire bill for services incurred in this office, are expected to pay in full at the time of service.
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Third Party Billing
This office does not perform 'third party billing'. In the event of an accident, etc., the patient is responsible for all charges incurred at the Practice and, in turn, responsible for filing own insurance with third party.
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Health Insurance Coverage of Medical Services
Our office makes concerted efforts to provide care within the scope of services covered by your insurance policy and that your tests are performed in the properly designated facility. If you are concerned that your insurance company may not cover services you will receive, please consult your insurance company prior to the date of service. In the event your health insurance plan determines a service to be not covered, you may be responsible for this charge.
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Dependent Child/Children of Divorced Parents
The responsibility for payment for services rendered to any dependent children whose parents are divorced rests with the parent who seeks treatment. Any court ordered responsibility judgment must be determined between the individuals involved without the inclusion of our office.
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Payment for Laboratory Tests and Radiology Services
Laboratory tests and radiology services are provided by separate businesses. You will receive separate bills for these services. We will make every effort to make certain that your services are covered by your insurance policy. If you are concerned that your insurance company may not cover services you will receive, please consult your insurance company prior to the date of service. In the event your health insurance plan determines a service to be not covered, you will be responsible for this charge.
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Payment for Copies of Medical Records
Medical records can be copied and sent to another provider at no cost to you. This includes 5 years of clinical notes, and 3 years of test results. If you wish to have a copy of your records, you will be charged for the cost of copying the record. This charge must be paid before records are mailed or picked up. According to NCGS Section 940.411, our fee schedule is $0.75 for pages 1-25, $0.50 for pages 26-100, and $0.25 for pages 101-plus. You will also be charged for postage.
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Payment for Completion of Medical-related Forms
A $45 charge will be incurred for one of our providers to complete any medical forms without an office visit (insurance policies, physical forms, Family Medical Leave Act, disability applications, etc).
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