COMPANY HOURS PAYMENT POLICY
Picture Identification. In order for the facility to file an insurance claim, a picture ID is required for patients 18 and older. For a minor 17 and under, an ID must be obtained from the parent, legal guardian, next of kin or accompanying adult.
Balance. Previous balances owed to the facility will be requested at time of registration.
Insurance. The facility will accept assignment of insurance benefits. The patient is responsible for co-insurance, non-covered services, co-payments, and/or deductibles at the time of service. If verification of a co-payment cannot be obtained, the patient is required to pay the specialist co-pay or $_____ for the visit. If insurance is a non-contracted plan (out-of-network), the facility will courtesy file the claim for services rendered.
Private Pay. If no insurance coverage, fees are due at the time of service. $___¬¬¬¬_____ will be collected at the time of check-in and the balance will be paid at check out. The balance of all charges including the exam fee, and any additional fees for diagnostic tests, supplies, and procedures are offered at a discounted rate for our out-of-pocket patients.
Payment Options. Apple pay, most major credit cards, debit cards, and cash are acceptable payment options.
Medicaid. We will accept Medicaid recipients enrolled only in contracted plans.
Discharge. The facility has the right to withhold discharge paperwork and prescriptions in the event of non-payment
RESOLVING BARRIERS OF COMMUNICATION AND INSTRUCTION
When indicated or requested, the facility will provide resources to resolve barriers to effective communication or educational instruction that may prevent understanding information about your health status, treatment, or the informed decision making process. Barriers may include foreign language, hearing or speech impairment, difficulty with reading or writing, or inability to comprehend verbal instruction.
State laws uphold the fundamental rights of adult persons to control the decisions relating to life sustaining procedures and end of life health care. Formulation of an Advance Directive (Living Will/ Power of Attorney for Healthcare) should be discussed with your family, spiritual advisor, legal counsel, and/or primary care. If you provide a copy of an Advance Directive to this facility it will be noted in the medical record though the directive may not be honored unless specific direction is given by the provider.