Our practice is based on bylaws described in the internal policy manual consistent with the national accepted regulations. Some of our forms and declarations are available for your information and may be downloaded and printed for your convenience. Below you may also find some helpful resources to facilitate the best communication between you and us. For any other questions, please contact us directly and we will happily provide the necessary clarifications.
Personal Information Update: You agree to provide our office with accurate updated contact information including address, personal phone numbers (including work, cell and home) and emergency contact information. However you are required to present an official photo ID each visit.
Payment policy and Insurance information:
We accept numerous insurance plans and you are responsible for informing us about any change in your carrier or plan. However we require insurance ID for benefits verification and claim filing with every visit. If you are unable to provide adequate insurance information, the entire service will be charged at the time of visit. You are responsible for the copayments and deductibles due at the time of service. We accept cash, debit and credit cards. We do not accept personal checks. You will only be sent a statement if your balance exceeds $5. Refunds will be issued within 4-6 weeks from the date requested, if there are no pending insurance claims. We realize that temporary financial problems may affect timely payment. We urge you to contact us promptly for assistance. In special circumstances we may offer you the option of an extended payment plan. Any unpaid balances older than 30 days may be subject to monthly interest. If your account is assigned to a collection agency, you will be responsible for any costs incurred in collection of said balance, which will
include collection agency fees of 30%, court costs and attorney fees.
We will file the insurance claim but it is your responsibility to understand your plan’s requirements regarding your personal contribution. Should your insurance carrier persistently refuse to reimburse the claim despite our efforts to provide adequate information and a reasonable amount of time for processing it, the responsibility for resolving the dispute becomes yours. We must emphasize that as medical providers, our relationship is with you not your insurance company. We attempt to verify your benefits. Please be advised this is only an estimate of your coverage based on the information given to us at the time of the inquiry. Not all services are a covered benefit with all insurance plans. It is your responsibility to be aware of what service(s) is being provided to you and if it is a covered benefit under your insurance policy. You are responsible for any non-covered charges not payable by your insurance policy.
Missed appointments: We appreciate your business and your time and we ask you to provide us in the same manner with a courtesy 24 hours in advance notice if you can’t keep your appointment, so we can accommodate another patient and reschedule your encounter at another convenient date. If you fail to notify us, your visit will be recorded as “No show” and followed by a notification letter mailed to you. Due to time sensitiveness of certain services in our profession, we understand we can’t maintain an absolute level of care and we will discharge you from our practice after 3 “No shows” in 1-year period.
Higher standards: We proudly offer the highest level of care that you need. Your opinion helps us individualize our approach to your needs and your feedback is valuable to help us constantly improve. Please take few minutes of your time to fill out the patient satisfaction survey. We welcome and we thank you also for any additional gesture you may wish to make in order to share your experience with other women in need for top quality care, including internet or published reviews of your provider.