Patient Information

PAYMENT POLICY

All patient fees are the responsibility of the responsible party.

Payment in full is expected at time of service.

A five (5) percent saving is offered for payment in full by cash or check at time of service.

A one (1) percent saving is offered for payment in full by credit card or debit/check card at time of service.

If payment in full at time of service is not feasible, credit is extended as a courtesy.

A billing fee will be added to your account for each monthly statement showing an unpaid balance over 30 days.

Payment will be applied to billing charges and cancellation fees first.

A minimum monthly payment of $100.00 is due by the date shown on the billing statement.

For patients with insurance that pays the subscriber, following the subscriber's receipt of the insurance payment this office is to receive the amount the insurance company paid as well as a minimum monthly payment of $100.00 toward the after insurance balance by the date due on the monthly billing statement.

If a minimum monthly payment is not received, any scheduled appointment(s) may be cancelled.

If a minimum monthly payment is not received one month, the following month the missed payment as well as the next minimum monthly payment are due and expected.

If payment is not received for 90 days, the account balance will be placed for collection.

Account balance to be paid in full within one six (6) months from date of service.

All other financial arrangements require a written agreement. Please consult with the Office Manager.

If this policy is not complied with, the account balance will be placed for collection.
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