We have prepared the following financial policy to help you understand your insurance plan, our billing practices and your responsibilities regarding payment for your medical services. Hopefully this will avoid confusion and misunderstanding.  We will ask you to sign the Patient Financial Obligation Agreement below after reviewing this policy and before your initial visit.

Please review this information carefully since it reviews your financial obligations and rights.

What payments am I responsible for?

Health care is a professional service much like that provided by your Attorney, accountant or financial adviser. We provide service directly to you or on behalf of you. Ultimately you are responsible for all care that you receive from us.  Your insurance company will help to defray or reduce those costs if we have a contract with them.  The amount left over (patient account balance) is determined by the details of your plan, such as the limitations of your coverage, deductibles, and co-pay. See Insurance/Billing FAQ for further information about this. 

Patient Financial Obligation Agreement

Insurance and Billing Process:

Your insurance is in agreement between you and your insurance company.  As a courtesy to you we will follow your insurance claims for you if you assign the benefits to the physician. your internist he requires us to collect your co-pay amount, deductibles and any other out-of-pocket expenses due at that time of service. if your insurance come he does not pay within a reasonable period or denies payment, we will send you a billing statement indicating the patient account balance for which you then are responsible.  If we later receive a check from your insurer, we will refund any over payment to you.

It is your responsibility to inform our staff when the cause of treatment may be the responsibility of her third party-Auto insurance, liability insurance company, Workman`s Compensation- instead of your regular health insurance carrier.  You are responsible to provide the office with all information required to build the third party when you check in for your appointment. you are also responsible for probably responding tear insurance company to provide any additional information they may request concerning your treatment, pre-existing conditions, accidents or other insurance for breech.  Failure to respond in a timely manner may result in your patient account balance becoming due and payable, in full, immediately.

If you are a workman's compensation patient who refuses to provide your personal health insurance as a backup or if you choose not to assign the benefits of your personal health insurance to the physicia, your account will be designated as a self-pay account. Charges will be payable in full at the time of service.

Be prepared to present you insurance card and proof of identity (e.g. driver`s license) at each office visit.  He will be responsible for providing a change address, telephone number, other contact information and/or insurance information anytime a change occurs.

We will look to the adult accompanying a minor for payment of all services rendered to minor patients unless other arrangements have been made.

Self-pay accounts:

We designate accounts in a self-pay under following circumstances: patient does not have health insurance coverage, patient is covered by an insurance plan that our providers cannot participate in, patient does not assigned he benefits from their health insurance to the physician, patient does not have a current, that would insurance card on file or the patient does not have a valid insurance referral on file. For such accounts all charges are due and payable in full at the time of service.

Payment Is Due at the Time of Service:

We accept cash, personal checks, money orders, most major credit cards and debit cards. A $25 fee will be charged for all checks which are returned due to insufficient funds.

Insurance required copayments are due at the time of service.  If you were unable to pay copayments at the time of service, you will be responsible for a $6 service charge.

Patient responsible balances are due at the time of service.

Your copayment amount is subject to change depending on your insurance plan and/ or any procedures that may be provided during your visit.

All outstanding patient account balances must be paid prior to your next office visit or you may not be scheduled until payment is made.

Overdue patient account balances that are sent to collections may be charged a collection service fee.


You are responsible for managing your insurance.  If your insurance company requires a position referral, you are responsible to have your primary care physician send a referral to our office prior to your appointment.  If you do not have a current, valid referral, we may need to either rescheduled your appointment or ask you to pay for the visit at the time of service.

Our responsibility To Report Noncompliance:

It is our responsibility under many insurance contracts to report patient's who: repeatedly refused to pay copayments, or who repeatedly “no show” for appointment.  If you are unable to keep your appointment, you must contact us and cancel at least 24 hours in advance or be responsible for a $20 no show fee.

Divorce Cases:

In case of divorce, the individual who receives care is responsible for payment of copayments, toe insurance, deductibles and nonparticipating insurance balances.  We will not bill a divorced spouse for the patient's services.

Child Custody Cases:

The parent who brings the child to the office for care is responsible for payment at the time of service no matter if the amount is self-pay, participating insurance, or nonparticipating insurance.  The practice does not honor divorce specifics (e.g. percentage of financial responsibility).

If the child has coverage with a participating insurance plan and the proper insurance identification is presented at the time of service with assignment of  benefits to the physician, we will bill the insurance company.

Delinquent accounts:

We reserve the right to report delinquent accounts to credit bureaus, assess a collection fee, take other collection action or terminate you as a patient of the practice.

For questions about or help with your health insurance or patient account balance:

You may contact our insurance/billing representative Renée at (724)-933-3300 Monday through Friday from 8 a.m. to 4 p.m. to discuss questions or payment options.