General Info

• Please bring your health plan cards with you to your appointments as we use this information to bill them directly. If you do not have your card, you will be required to make a deposit of $200.00. This will be refunded once we verify your insurance information.
• Co-payments are expected to be paid at the time of visit.
• Any costs not covered by the insurance company are the patient's responsibility and must be paid within 30 days.
• Referrals are your responsibilty to obtain prior to appointment.

MVA/THIRD PARTY LIABILITY POLICY

• We require an initial $200.00 pre-payment on your account with subsequent payments of at least $50.00 per visit, in order to keep your scheduled appointment.
• Please note that after each visit to our ofice, we will mail the insurance claim forms to you. This indicates charges for that day. You need to send each one to your liability insurance. We WILL NOT file third party liability insurance.
• If you have an attorney, please give us his/her name and address and phone number.
• Your medical insurance will be billed as secondary only after payment by liability insurance is complete - or if we receive a written denial from your liability carrier.
• You will receive a monthly statement from our office. If there is any delay in payment, we ask that you, or your agent/attorney, contact us each month with a status report.

**NOTE: FINANCE CHARGES WILL BE ADDED TO THIS BALANCE IF NOT RESOLVED WITHIN 90 DAYS.

If you have any questions or concerns, please contact our insurance department at: (913) 642-0200, option 2