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Family Practice Partners' Payment Policy

Family Practice Partners Payment Policy

Thank you for choosing us as your primary care 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 this payment policy. Please read it, ask us any questions you may have.  A copy will be provided to you upon request.

1. Insurance. We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured by a plan we do business with, but don’t have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.  If your visit will clearly not be covered by an insurance plan, and you pay for your visit at the time of your service, you will be entitled to a discount for your prompt payment.

2. Co-payments 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.

3. Non-covered services. Please be aware that your doctor may consider a service necessary for your care while your insurance company may not cover it’s cost.  Some – and perhaps all – of the services you receive on any given visit may be noncovered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit.

4. Proof of insurance. All patients must complete or verify the correctness of our patient information form before seeing the doctor. We must obtain a copy of your current valid insurance card to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you will become responsible for the balance of a claim.

5. Claims submission. As a courtesy to you, we will submit your claims and assist you in any way we reasonably can to help get your claims paid. 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 party to that contract.  If your insurance company does not pay your claim in 90 days, the balance can be considered to be your responsibility.

6. 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.  Failure to notify us may lead to providing services that the insurance does not pay for and that will be your responsibility.

7. Nonpayment. If your account is past due, you will receive a letter stating that you must pay your account in full. Partial payments will not be accepted unless an active payment plan is negotiated. Please be aware that if a balance remains unpaid, you may be refused care until the balance is paid.  Repeated episodes of failure to pay may lead to your discharge 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.  Such a dismissal may also involve immediate family members receiving care at this practice.  We reserve the right to turn unpaid accounts over to a collection agency.  Costs associated with this process will be your responsibility.

8. Missed appointments. Our office needs to know what times are available to provide care to those needing care.  We reserve the right to charge a fee for missed appointments not canceled within a reasonable amount of time. These charges would be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment.

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.

I have read and understand the payment policy and agree to abide by its guidelines:

______________________________________                    _____________

Signature of patient or responsible party                             Date



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