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Payment Policy / Insurance Advance Notice

Date of Upcoming Service

Payment Policy

It is the policy of The Center that all services be paid for at the time of visit. We accept Cash, Check, Visa and MasterCard. However if we have made other arrangements with you the following outlines our billing and collection policy.

 

Insurance Advance Notice Form

This is a provider notice to the beneficiary regarding the services that may or may not be covered by your insurance company. Medical insurance is for your protection against the cost of medical care. Your insurance policy is a contract between you and your insurance company. There are literally thousands of insurance programs in existence. It is impossible for us to be familiar with all the programs. It is your responsibility to know if our office is covered by your insurance. If our office is not covered by your insurance, upon leaving our office we will supply you with a bill for the services that you received. It is then your responsibility to file the claim with your insurance company. You may contact your insurance company for information on submitting your claim.

If we elect to accept your insurance and file your claim, it does not guarantee that your insurance will pay the claim.

You are still responsible for any unpaid balance. All balances that remain unpaid for a period of 90 (ninety) days or longer will be considered delinquent and turned over to our collection agency.

Medicare

 

Our office accepts assignment on Medicare claims, that we will file your claim with Medicare and accept the approved Medicare rate as our total charge. However, by law we must collect the applicable co-insurance and deductible. If you have a Medicare supplement that Medi-Gaps over, we will file with them for your deductible and co-insurance. If your supplemental policy does not cover the deductible and co-insurance or other non-covered services, payment for these services will still be your responsibility.

I understand I have a right to appeal directly to my insurance company, not to the Center.


Workers Compensation

We will bill your workers compensation insurance carrier and accept this as payment in full. However, if your worker's compensation carrier denies benefits (such as  determination that the injury is not work related), then you will be responsible for any unpaid balance. If you have any questions concerning the payment policy, please feel free to contact the Center,  Monday-Friday 

By signing below, you are agreeing to the payment and insurance policy of the center and you understands its requirements outlined in details above.

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