The management has approved the policies listed herein to provide our patients with the finest care and services at the best cost.

The services delivered by this office are provided regardless of race, color, social status, national origin, handicap, or gender. We are committed to providing you with the best possible care. To accomplish this, we can assist in reading and understanding financial responsibility and our payment policy.


It is the expectation that all patients/guarantors receiving services are financially responsible for the timely payment of the charges incurred. While the office will file the verified insurance claims for payment of the bill(s) as a courtesy to the patient, the patient/guarantor is ultimately responsible for payment and agrees to pay the account(s) under the regular rates and terms of the practice in effect at present.


Payment for service is due when service is provided, and non-emergency services may be declined until the necessary payment arrangements have been accomplished. The office will accept payment in cash, checks, and all major credit/debit cards. We will happily file claims to your verified insurance policy on your behalf.

For your convenience, if your check is dishonored or returned for any reason, we will electronically debit your account the check amount plus a processing fee of $50.00. Patients paying out of pocket for the services rendered are considered self-payments.

Patients unable to comply with the Point-of-Service payment policy will be directed to the administrative office for necessary arrangements.


The practice will make a reasonable effort to assist patients in meeting their financial obligations. The office will decide on financial arrangements for payments at its discretion, based on the amount of the patient’s liability and the patient’s ability to pay based on the completed credit application.


The practice will accept “Assignment of Benefits” on verified insurance policies and submit a bill to the carrier on the patient’s behalf. It is understood that insurance is filed as a courtesy to the patient and does not relieve the patient of financial responsibility. Claims filed will be held for 45 days pending payment. The patient/guarantor will be responsible for payment in full on all the claims not paid within the allowed period.


Because of the wide range of insurance plans in effect, the clinic will verify insurance coverage, deductibles, and other limits before acceptance for payment of services. If we cannot verify an active policy, you will be asked to pay for services at the moment of render.


Our staff is trained to assist you with insurance questions. Your employer or group health administrator is whom you should seek to address coverage issues. Although our assistance is available, we cannot mediate on your behalf.


Signing our release of information form gives us the authority to release information necessary to collect from insurance companies and other third-party payers.


Balances after insurance are due within 30 days of the insurance payments unless other satisfactory arrangements have been made with the practice.

Insurance companies cover not all services. It should be understood that by accepting the service(s), the patient is responsible for payment regardless of whether insurance covers the service.

The practice cannot become involved with any third party for financial liability matters. It must always look to the patient/guarantor to pay the bill.


The clinic reserves the right to request deposits and payments for outstanding balances. Deposits will be based on the outstanding balance plus the patient’s share of the bill for the new services.


The clinic reserves the right to file healthcare liens against the patient and other responsible parties as is deemed appropriate to protect the practice interest.


If the account is not paid in complete or satisfactory arrangements are not made within the allowable time frame, the practice reserves the right to refer the account to an attorney and a collection agency to collect the balance.

The administration and management welcome the opportunity to discuss any aspect of the financial policy. We appreciate your confidence and strive to provide quality healthcare.

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