IMPORTANT INFORMATION
- PLEASE READ
SURGICAL ASSOCIATES FINANCIAL POLICY
Thank you for choosing us
as your health care provider.
Please understand that payment
of your bill is considered your responsibility. The following is a statement
of our FINANCIAL POLICY.
WE REQUIRE ALL PATIENTS COMPLETE
OUR INFORMATION FORMS BEFORE SEEING THE DOCTOR.
INSURANCE (other than
Managed Care)
Your insurance policy is
a contract between you and your insurance company. We are not a party tot
hat contract. payment is due at the time office services are rendered.
You will be furnished an itemized statement at the completion of
your office visit so that you may file for reimbursement. We will automatically
file for all outpatient and hospital services even though your insurance
plan is not a plan in which we participate. You may be required to pay
your deductible and coinsurance prior to your surgery or procedure.
If your insurance has not paid on your account within 45 days, you will
be asked to pay for your services even though your insurance is pending.
This may be paid by cash, check, Visa, MasterCard, Discover, or American
Express. We also offer an extended payment plan with prior approval.
MANAGED CARE INSURANCE
We file for all office visits,
outpatient and hospital services with PPO's and HMO's in which we participate.
Copays are due at the time of service. You may be required to pay your
deductible and coinsurance prior to your surgery or procedure. If you
do not have your insurance card with you at the time of your visit, you
will be expected to pay for your visit at the time of service. Please remember
that it is your responsibility to keep us informed of any change in insurance
status. If your insurance requires an authorization from your primary care
physician prior to seeing one of our physicians, it is your responsibility
to obtain that authorization.
MEDICARE
Surgical Associates are participating
physicians in the Medicare program. We will file the claim with Medicare
and will accept Medicare's allowable payment. You will be billed for the
20% coinsurance and any deductible. if you have secondary insurance, we
will file your secondary insurance for you after the Medicare payment has
been received.
USUAL AND CUSTOMARY FEES
We charge what we consider
is usual, customary and reasonable. You are responsible for payment regardless
of any insurance company's arbitrary determination of another usual, customary
and reasonable fee.
NO INSURANCE COVERAGE
Payment is due at the time
of service unless prior arrangements have been made. We accept CASH, CHECK,
VISA, MASTERCARD, DISCOVER OR AMERICAN EXPRESS.
Please ask to speak with
someone in our business office prior to seeing the doctor if payment arrangements
are necessary.
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