Financial Policy

Please help us to continue to provide the quality of service you expect.  Please review the following financial policy.  Any questions or concerns may be directed to the Practice Administrator.

Full payment is required at the time of service unless prior arrangements have been made:
We accept cash, checks and credit cards including Visa, Master Card and Discover.

Prescription Policy:
We are pleased to be able to provide prescriptions for your medications at the time of your office visit. During your visit your provider will go over any details about medications prescribed, how the medication is to be taken as well as the frequency of refills for these medications. Your provider will also discuss whether or not generic substitution for the medication is appropriate in your individual case. Please tell your provider whether a monthly or quarterly supply of continued medications would be preferable.

Any further inquiries as to new prescriptions, prescription refills or changes in existing prescriptions may incur a further charge prior to being authorized. In some instances an office visit may be necessary to determine whether a medication needs to be prescribed. Once again, as a reminder, after-hour prescriptions for narcotics will not be filled by the providers in our office.

Patients under the age of 18: 
Any patient under the age of 18 must be accompanied by a Parent or Guardian who will be responsible for providing current information and payment at the time of service. This office is not bound by any divorce decree or other family relationship contracts.

Private Insurance with which we do not have a contract: 
Your insurance policy is a contract between you and your insurance company.  We are not a party to that contract.  It is the responsibility of you, the patient, to provide this office with current information.  Because we do not participate with your insurance company, payment for office visits are due at the time of service.  However, after payment of your office visit, we will file all claims as a courtesy to you.  For all other services, you will be responsible for any deductible, or any non-covered services.  Non-covered services include but are not limited to complete annual physicals, immunizations and some diagnostic testing.  Your bill with the physician is your responsibility.  If your insurance payment is not received within 60 (sixty) days, any remaining balance will automatically become due from you.

UCR (Usual & Customary Reimbursement): 
Considerable care has been taken in setting our fees.  We want to assure you that our charges accurately reflect the complexity of care rendered and the skill and expertise required for your care.  We assure you that our fees reflect what is usual and customary for our geographical area.  If your insurance company's fee schedule falls below the level of our charge, you will be responsible for payment in full (unless we have a written contract with your insurance company).

Managed care contracts: 
We currently participate in some "Managed Care" insurance programs.  If you are covered by one of these identified programs, you will be required to pay any co-pay, deductible or non-covered services at the time of service.  It is your responsibility to present your current insurance plan I.D. card.

Medicare patients: 
We are participating physicians with Medicare.  This means that you are responsible for 20% of the approved Medicare fee, the yearly deductible and full payment of any non-covered services. Non-covered services include but are not limited to complete annual physicals, immunizations and some diagnostic testing.  This office will file any secondary insurance claim as a courtesy to you, our patients.  You will be asked to sign a waiver for any non-covered services that may not be covered under this plan.

Medicaid/Hoosier Health Wise: 
You are required to present, at the time of each visit, a current I.D. card.

Litigation cases: 
(auto accident or any liability injury)  You are responsible for all fees incurred.
Worker's Compensation: We require pre-authorization from your employer.  This office will file your claim with the appropriate insurance company.  However if the worker's comp claim is later disputed, you will be responsible for payment in full.

Professional Courtesy: 
In accordance with Federal law and other Regulatory Agencies, this office will be unable to provide "Professional Courtesy."

Collection/Bankruptcy: 
If your account becomes delinquent, and sent to an outside agency or attorney for collection, you will be responsible for all costs, including agency fees, attorney fees, court costs, and any other related expenses.  This practice reserves the right to discontinue the physician-patient relationship in the case of collection or bankruptcy.

Returned Checks: 
A fee of $20.00 may be charged for each check returned to us.
Duplication of Medical Records: A duplication fee may be charged up to an amount allowed by state law.

If you have questions about this policy or our fees, please contact our financial advisor.

We accept:

Our compliance plan requires that all charges be audited by our certified coders before your insurance company is billed. You will receive a receipt for payments made, but we will only be able to give you an approximate total of your charges at the time of your visit.

An exact fee cannot be quoted before surgery, since it is unpredictable what the findings may be at the time of surgery and what specific procedures may need to be performed.

Please consult with our business office for obstetrical care fees. Fees are difficult to estimate prior to your appointment, since the extent of the examination and/or tests may vary from one patient to another. However, our business office can quote approximate charges for office visits and scheduled laboratory tests, surgery and obstetrical care.