Insurance Page 2

Patients (parents of child patients) are ultimately responsible for all office charges, and payment is expected at the time of service. For patients paying us directly, a 10% discount is available for payment in full at the time of the visit. In cases in which a contractual relationship exists between our office and your insurance plan, you are asked to pay any co-payment or co-insurance at the time of the visit (we are required, by contract, to collect this from you at the time of the visit). You may also be asked to pay your deductible portion at the visit as well. You may pay by cash, check, or credit card. Our participation in various insurance and managed care plans is subject to change; in general, we attempt to “sign up” with as many plans as possible in order to maximize choices for our patients. A current list of insurance plans in which we participate may be found by calling our office. We are happy to bill most insurance carriers directly; however, patients are ultimately responsible for any charges incurred. Patients are ultimately responsible for any charges or portion thereof for which payment is denied by insurance for whatever reason, except where prohibited by law or prior contractual agreement. In cases where the insurance company will not respond promptly and/or properly to our claim submission, patients will be contacted to assist in prompt resolution of the matter.

Unpaid balances are billed monthly. We use computer billing and are aware that sometimes errors do occur. Please call if you have any questions about your bill. Most problems can be settled quickly and easily, and your call can help to prevent any misunderstandings. If you are having trouble paying your bill or are unable to pay on the day of the visit, please explain the situation to us; satisfactory arrangements can almost always be made. We strive to remain flexible and understanding of individual circumstances. Financial considerations should never prevent someone from receiving the care they need at the time they need it.