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Financial Policy
Click here to
view and print out our financial policy document as a pdf file |
We are committed to providing you with the best possible care and are
pleased to discuss our professional fees with you at any time. Your
clear understanding of our Financial Policy is important to our
professional relationship. Please ask if you have any questions about
our fees, or your financial responsibility.
PATIENTS MUST FILL OUT PATIENT INFORMATION FORMS PRIOR TO SEEING THE
DOCTOR. WE WILL ASK TO SEE YOUR INSURANCE CARD ON EVERY VISIT AND WILL
SCAN YOUR CARD INTO OUR SYSTEM AS NEEDED TO KEEP OUR INFORMATION
CURRENT.
COPAYMENTS: Your insurance REQUIRES that we collect your
designated co-pay at the time of service. Please be prepared to pay
the co-pay at each visit.
SELF-PAY: Self-pay accounts shall exist if a patient has no
insurance coverage. For new patients, a payment of $100.00 is expected
on the day of your appointment before being seen by the health care
provider. If you are unable to pay the $100 please contact the billing
office prior to your appointment.
EXTENDED PAYMENT PLANS: Patients are encouraged to pay
outstanding self-pay balances in full. However, payment plans may be
accepted with approval of the business office.
NON-PARTICIPATING INSURANCE PLANS: As a service to our
patients, we will bill as a non-assigned claim. Any outstanding
balances are the responsibility of the patient.
REFERRALS: If your plan requires a referral from your primary
care physician it is YOUR responsibility to obtain it prior to your
appointment and to have it with you at the time of the appointment. If
you do not have your referral, YOU MAY BE REQUIRED TO RESCHEDULE.
ACCIDENT/WORKERS COMP CASES: Patients shall be financially
responsible for medical services related to accident/workers comp. It
is the responsibility of the patient to notify Falmouth Orthopaedic
Center of: date of injury, claim#, insurance company address, phone#,
and contact person.
MEDICARE: We will submit to Medicare for the Medicare allowed
amount. The patient will be responsible for the
deductible and the co-insurance, which can be billed to a secondary
insurance if you have one.
RETURNED CHECK FEES: Any returned check from the bank for
non-payment (insufficient funds) shall result in the patient's account
being assessed a $25.00 fee per check returned.
CHILD CUSTODY CASES: Falmouth Orthopaedic Center will bill the
insurance carrier for both parents. However, the parent that signs for
services will be responsible for all outstanding charges and balances
unless you have a court
order otherwise.
WE ACCEPT CASH, MASTERCARD, VISA, DISCOVER AND CHECKS
If you have any questions please call Kathy in the
Billing Department at 207-781-4446. |
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