Payment Policy: Copays, coinsurance, and deductible payments are required on the day of service. If these are not paid at the time of your visit, a $15 processing fee will be applied.
Card on File Policy: To ensure smooth and secure payment processing, we require a credit card (HSA, VISA, Mastercard, or Discover) on file prior to your appointment. This card will be used for any outstanding balances once your insurance claim has been processed and the insurance portion is posted to your account. If valid insurance information is not provided at the time of service, the card on file may also be charged.Please note: You will always receive a statement, and your card will only be charged if no payment is made within 20 days of receiving the statement.
Referrals: If you have an HMO insurance that requires a referral (such as Keystone Health Plan East, Aetna HMO, Tricare Prime, or other HMO), the referral MUST be called in by your primary care doctor to our office PRIOR to the visit. Otherwise, you will be responsible for the entire cost of the visit. Obtaining a referral is the patient's responsibility.
Cancellations: Please ensure that all cancellations are made at least 24 hours prior to your scheduled appointment to avoid a $25 late cancellation or no-show fee. If there are two instances of no-shows or late/same-day cancellations, we will discharge you from our practice, and you will no longer be able to receive care, unless a $72 reinstatement fee is paid. We appreciate your understanding and cooperation in helping us maintain a smooth schedule for all patients.
Form Completion Policy: We are happy to help with any forms you may need for work, school, insurance, or other purposes. Completing these forms takes time and careful review to ensure all information is accurate and complete.
Please note the following guidelines:
-Processing Time: Please allow up to 10 business days for form completion. Our doctors carefully review each form to make sure everything is filled out correctly.
- Fee: There is a $25 administrative fee per form, which covers the time required to complete and review your paperwork. This fee is not covered by insurance. More complex or forms longer than one page will incur additional cost.
-Urgent Requests: If you need your form completed sooner, we’ll do our best to accommodate you. Expedited requests (within 48 hours) may be available for an additional $50, depending on the doctor’s schedule.
-Submission: You may drop off your form at the front desk or email a clear copy to our office. Please make sure your portion of the form is completed and signed before submitting it.
- Pick-Up: Completed forms can be picked up at the office, faxed, or emailed to the appropriate recipient upon request.
-Appointments May Be Required: If your form requires up-to-date medical information or documentation from a recent exam, we may ask you to schedule an appointment before completion.
Thank you for your understanding and cooperation-this helps us provide accurate and timely service to all our patients.
