STEP 4

Our Financial Policy

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Hippa Law states that our patients must fill out their name and birth date on all forms.

OUR FINANCIAL POLICY

  • 1. We are dedicated to providing the best possible care and service to you and regard your complete understanding of your financial responsibilities as an essential element of your care and treatment.

    2. At the time of registration, and periodically thereafter, you will be asked to complete a registration form and must present proof of insurance and a current state photo ID or driver’s license. This allows our office to keep personal and insurance information accurate. Failure to present this information may result in rescheduling your visit.

    3. We participate in most insurance plans, including Medicare. We will submit your claims and assist you in any way we reasonably can to help get your claims paid.

    4. It is our office policy to collect payment when you arrive for your appointment unless you have made prior arrangements with our business office. This includes co-payments, deductibles, payment plans and any other outstanding balance. For your convenience, our office accepts cash, checks, MasterCard, Visa and money orders. There is a $25.00 fee for any returned items including mailed payments and reversed credit card charges.

    5. If your insurance plan requires a “referral” from your Primary Care Physician, you will be responsible to contact them for the referral. Treatment provided without the required authorization may result in the need to reschedule your visit.

    6. Patients without insurance or uncovered benefits will be expected to pay at the time of service unless prior arrangements have been made through our business office.

    7. We will bill your health plan for our services provided in the hospital. Any balance due is your responsibility. High deductible plans may require a down payment prior to treatment.

    Any questions, please call our business office @ 616-459-0898 or (800) 606-1455.

    I have read and understand the practice's financial policy and I agree to be bound by its terms. I also understand and agree that such terms may be amended by the practice from time to time.