ALTOONA OBGYN ASSOCIATES, INC. FINANCIAL POLICY
We provide you with the best possible care and service. We consider your understanding of our financial policies an essential element of your care and treatment. We find that communication with our patients regarding our policies assists us in providing the best service possible. The following is our Financial Policy, which we require you to read and agree to prior to your treatment.
We participate in most insurance plans. We will file claims for all services we provide in the office and at UPMC Altoona. If you are not insured by a plan that we participate with, payment in full is expected at each visit. Please remember that insurance coverage is a contract between you and your insurance company. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.
We are a participating Medicare provider. Medicare as well as your secondary insurance (if any) will be billed for you. However, that does not mean that all the services are covered. Patients are responsible for paying their annual unmet deductible. You are also responsible for any co-insurance, which is usually 20% of the allowed amount for a service.
Non-Covered Services (3)
Medicare and some Medicare Advantage plans will only cover your yearly exam and pap smear every other year. If this happens, it is your responsibility to pay for our services. We will make every effort to inform you of what services may not be covered by your insurance plan, but you will still be responsible for all the balances.
Patient Billing (4)
All copayments must be paid at the time of service. Any additional services may incur additional charges along with the charge for your yearly exam. If a balance is due after receiving the explanation of benefits from your insurance company, you will be sent a billing statement. We ask that all balances are paid in full no later than 90 days from the date of service. If the balance remains unpaid after 90 days, your account will be fowarded to a collection agency. Please notify our billing office if you are unable to pay your bill in full. Special payment arrangements may be available.
Claim Submission (5)
We will submit your claim to your insurance company. However, your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Any unpaid balance not covered by your insurance is your responsibility.
Copy Fee (6)
We will provide copies of patient records at the patients’ request. Copies of records may be subject to a per page fee as follows: 1-20 pages are $1.83 per page; 21-60 pages are $1.36 per page and 61+ pages are $0.47 per page. (Fees are subject to change)
Forms Fee (7)
Forms including FMLA, Disability, etc. may take 7-10 business days to be processed and are $25 per form. (Fee is subject to change)
Canceled/Missed Appointment Fee (8)
If you cannot keep your appointment time, please call our office at least 24 hours prior to your scheduled appointment time. If you fail to give us notice of your missed appointment, you will be responsible for a missed appointment fee. The fee for missed procedures (i.e.: ultrasound, IUD/Nexplanon, colposcopy, urodynamics) is $75.00. Missed gynecological appointment is $50.00. This charge is not covered by your insurance company and will be your responsibility. If you arrive late for your appointment, we may need to reschedule your appointment in fairness to other scheduled patients. Repeated missed or late appointments may result in dismissal from our practice.
When a surgical procedure is scheduled, we will give you an estimate of the amount you may be responsible to pay. This amount will be collected prior to the procedure being performed unless payment arrangements are made. Additional payments or refunds may be required after the insurance has processed your claim. Your insurance company will issue an EOB, explanation of benefits, indicating the responsible amount.
Minor Patients (10)
The parent or guardian accompanying a minor will be financially responsible for payment of services. Young adults (age 18 and over) and emancipated minors are legally responsible for their account.
I have read and understand the financial policy of this practice and I agree to be bound by its terms. I also understand and agree that such terms may be amended from time to time by the practice.
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