PAYMENT Fees
- Co-pay: Varies per individual plan; payable at each visit.
- Co-Insurance: Many plans require out-of-pocket payments in the form of a deductible or patient co-insurance. Until you satisfy your deductible or co-insurance amount, our charges are payable at the time of each visit.
- Missed co-pay: $10 each
- Missed Appointment: $50 - Well visit, $25 - Sick visit
- School/Camp Form: $10 per form per patient or $20 for two or more forms per patient when submitted simultaneously.
- Returned check: $25 each
- Collection charge: Individual
- After-hours Surcharges: Services rendered outside of our standard business hours may be billed with surcharges. Surcharges may apply to walk-in hours, late physicals and weekend/holiday visits. If late physical appointments are missed, the full physical fee will be charged.
Statements
- Your statement is mailed once a month and indicates your balance. Payment is due within 15 days from receipt of the statement.
- We will bill any balance due to your account after your insurance company responds to our filing.
- A balance 30 days past due is subject to an 18% annual interest charge.
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| Private Pay If you do not have insurance or if you have an insurance plan that we do not accept, fees for our services are charged directly to the patient (or guarantor) and payment is due at the time of service. We do not bill your insurance carrier but at your request, we will provide you with an invoice at each visit so that you may file a claim. |
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