Financial Policy

Self-Pay: Patients who are uninsured or fail to provide us with adequate billing information including proper managed care authorization referrals are responsible for the payment of their bill.

SELF-PAY PLAN

If you are self-pay, you will be expected to pay the day's charges on the day of the service. There may be additional charges for tests and other services rendered subsequent to your visit. You will be billed for these items. If you are having a surgery or are pregnant, you will be expected to make mutually agreeable payment arrangements prior to receiving the service. If the service is considered elective, payment must be made in full prior to the services being performed.

HEALTH INSURANCE

As a courtesy to you, we will submit medical claims to your insurance company. Any balance after processing of our claim by your carrier is your responsibility. Your insurance policy is a contract between you and your insurance company. We cannot bill your insurance company unless you give us your complete insurance information. Without complete insurance information you will be considered Self-Pay. Most insurance plans have a time limit to file claims, typically within 90 days of the original date of service. It is your responsibility to supply correct and accurate insurance information to Complete Women’s Care at the time of service to ensure all claims are filed correctly and within the timely filing deadlines. It is your responsibility to know your insurance benefits; your plan may not cover all of the services provided to you.

BILLING STATEMENTS

We have designed our billing statements to reflect the individual charges billed, the payments and adjustments related to those charges, and the balance due. These statements will also reflect an amount due from you, as well as a balance due from your insurance company. Patients with a personal balance will receive a monthly statement showing the specific amounts due. These statements are due upon receipt. Because the posting of payments can sometimes be posted  days following the day of payment, you may receive a statement that does not reflect a payment that was made on the day of service or sent by your insurance company. If you receive subsequent statements, which do not reflect the payment, please contact the office and speak with the billing department.

PAST DUE 90+

Those accounts older than 90 days or those failing to honor agreed-upon payment terms will be sent to a collection agency. If your account is sent to a collection agency, you must pay all past due amounts or make agreeable payment terms before subsequent appointments can be scheduled. Additionally patients can be dismissed from our practice for financial matters and will have to seek their health care elsewhere.

RETURNED CHECKS
The charge for a returned check is $35 payable by cash or money order. This will be applied to your account in addition to the insufficient funds amount. You may be placed on a cash only basis following any returned check.

This financial policy helps the office provide quality care to our valued patients. If you have any questions or need clarification of any of the above policies, please feel free to contact us.

Forms

COMPLETION OF FORMS (FMLA/Short Term Disability/Intermittent leave)

In order for us to better serve you, we request that you are aware of the following:

Your insurance company will not be billed as insurance companies do not reimburse for the time and judgment that are required to complete these forms. Please allow 7 business days for completion of forms. Payment is required prior to completion of all form(s). The fee for completion of forms varies from $20 to $30 depending on time and complexity.

In-House Companies

All pathology will be billed through Pathgroup.

Patient Billing Customer Service Toll Free Phone: 855-627-4002.

All ultrasounds performed in office are billed TWICE once for the Ultrasound tech that performs the exam and once for the radiologist that reads your report. Those services will be billed by The Perinatal Group.

Perinatal Group customer service: 615-462-5171.