Financial Policy

Patient Forms

Financial Policy

Our practice is committed to providing each of our patients with the highest quality of health care. It is therefore important to us that you understand the costs associated with your care. By informing you of our expectations, we hope to alleviate any misunderstanding or disagreement concerning financial responsibility. Please do not hesitate to contact our billing office with any questions or concerns.

Insurance Claims and Payment

While our physicians are participating providers for many different insurance plans, the list is not conclusive. Your insurance is a contract between you, your employer, and the insurance company. Payment for your health care services is ultimately your responsibility. It is therefore important that you verify provider participation and benefits with your insurance company prior to your visit. In most cases, we will file your claim(s) on your behalf regardless of whether or not we participate with your insurance plan.

We are not a provider for Workers’ Compensation.

Payment is due at the time of service for any amounts known to be not covered, or not paid, by your insurance plan. This includes all co-payments, coinsurance, and deductibles. Your insurance card must be presented for verification at each visit.

Notice: Both Ohio State Law and our contract with your insurance company require payment of your insurance co-payment at the time of service.

We accept cash, check, VISA®, MasterCard®, and Discover®

A service charge of $10 will be applied to your account for any co-payments not
received within seven (7) days from the date of service.

Billing & Collections

You should receive a statement approximately every thirty (30) days unless the charges are pending with your insurance company or your balance is less than $3.00. If a payment or denial is not received by your insurance company within ninety (90) days from claim submission, the total amount due will become your responsibility.

Any amount due remaining after your insurance has paid, denied, or not responded, is expected to be paid in full (by you) within ninety (90) days unless other financial
arrangements have been made with our Billing Office. Our formal collection process will begin after that time.

We realize that temporary financial problems may affect timely payment of your
account. If such problems arise, we encourage you to contact our Billing Office at
(614)273-2250. We will do our best to accommodate your individual situation.

Self-Pay and Cosmetic Procedures

If you do not have insurance, or are having a procedure that is not covered by
insurance, payment in full is expected on or before the date of service.

Surgical Services

Surgical services are not covered at 100% by most insurance plans. Once benefits have been applied, patients are frequently responsible for a deductible, coinsurance, and/or co-payment. It is therefore required that prior to surgery, financial arrangements be made to cover any balance due after the insurance company pays its portion. The following plans have been made available for your convenience.

Easy Pay

The “Easy Pay” plan is available for those patients with valid insurance plans that do not cover 100% of surgery. This plan eliminates the need to pay up front and allows you to wait until after your insurance has paid to pay your physician. By completing a consent form, you authorize your doctor to automatically charge your credit card for any balance due after your insurance has paid. You can choose to authorize either the total amount due or you can choose payments of $100 per month.

CareCredit

CareCredit is a program that offers a line of credit with no interest or low interest
payment options. It is “specifically designed for healthcare expenses, and makes it
easier for you to get the treatment or procedures you want and need. CareCredit is ideal for co-payments, deductibles, treatment and procedures not covered by insurance (CareCredit, Inc., 2003).” Please visit CareCredit’s website for details at
http://carecredit.com/patients/whatis.htm. Restrictions may apply.

Contact the Billing Office regarding these or other payment options that may be
available to you.

Responsible Party for Minors (18 years and under)

We assign all financial responsibility to the parent or guardian that completes and signs the patient registration form. Any amounts due at the time of service are expected from the parent or guardian accompanying the minor to the visit. The minor is responsible if unaccompanied. In the event that a divorce decree assigns distinct financial responsibility for medical bills to another individual, we still hold the registering parent or guardian responsible. We will however assist you in the recovery of such payment by providing you with receipts showing the payment that was made.

Questions? Contact the Billing Office at (614) 273-2250

 

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