Payment Policy
Payment Policy
Co-Pays:
We require payment of co-pays at the time of service, and reserve the right to refuse treatment.
No Insurance:
If you have no insurance, we collect the office visit before the visit and the remainder at the checkout. Self pay patients may receive additional bill for services rendered.
Payments:
Outstanding Account Balances:
We may refuse to see patients with an account balance and who are not making regular payments on their account balance. If you have an unpaid balance at the end of a billing cycle, we apply a $5 late payment fee to your account. If you make a payment and it is insufficient to pay both the late payment charge and the principle amount due, we apply your payment to the late payment fee due and then we apply the remaining amount to the principal. In the event that your account is placed for collection, a collection fee will be added to your account, along with any attorney fees and/ or court costs that may be necessary for recovery of the outstanding balance. In the event of an NSF check, there will be a $25 NSF charge added to the balance due.
Claim Filing:
We happily file your claim with your insurance company as a courtesy. We bill insurance in accordance with all federal, state and other contractual requirements in cases where we have an agreement or we are a participating provider. Please keep in mind that payment remains your responsibility. We are happy to help aid to get your claims paid, from time to time your insurance company may need you to supply certain information directly. We expect payment in full from you if your insurance company delays processing of your claim for over 60 days. You agree to pay any portion of the charges not covered by insurance. If your insurance company sends payments directly to you, send or drop-off the payment to RB Medical Practice, and we will apply it to your account.
Preauthorization:
Most insurance companies require preauthorization before you have a surgical procedure. Failure to obtain preauthorization may result in your insurance company refusing to pay your claim. Any refusal of payment by insurance for this reason is your responsibility.
Dependants:
You are responsible for payment of services rendered to your dependents on your account. In cases where a written court order allows payment for medical costs associated with a dependent, it is the responsibility of you to obtain reimbursement from the other party involved.
Forms/Letters/Medical Records:
The completion of disability forms, FMLA forms, attending physician statements, and other supplemental insurance forms all require office supplies, physician and staff time to complete, therefore a $10.00 fee for each form will be charged and must be pre-paid. Note, there will be a 14 day turnaround time for completion, so make arrangements accordingly. Non-standard or multiple page forms may result in a higher rate. The following procedures are not filed with insurance companies and are subject to prepaid amounts. Sports, college, and school (eye, ear & dental) physicals are a $100.00 prepaid fee. Pre-employment, and adoption physicals are a $100.00 prepaid fee. Any additional labs/procedures that are not included in these services may incur further charges.