Financial Policy

It is our goal to satisfy you and make the financial aspects of your health care as convenient as possible. Therefore as a courtesy to you, we will file most insurance.

We will need a photocopy of your insurance card in order to process your claim. Without your card, you will be responsible for full payment at the time services are rendered. If your plan requires an annual deductible, we will need you to bring an explanation of benefits statement/form from your insurance carrier that shows your deductibles have been met.

All patients who have insurance that require an authorization are responsible for obtaining the authorization. When no authorization has been received prior to your appointment, you must sign a waiver stating that you will be responsible for the bill. If you are not willing to sign the waiver, you may reschedule your appointment.

We file our claims electronically on the second business day after services are rendered. If your insurance company has not responded within sixty (60) days, the amount due becomes your responsibility. In addition, all residual balances not covered by your insurance are also your responsibility. We will accept assignment on your claim if we are contracted with your company.  If we are not contracted providers for your insurance carrier, you will be responsible for payment in full at the time services are rendered.

Self-Pay patients must pay $200.00 upon check in and the balance at check out. If your visit is less than $200, we will gladly refund the difference at the time of check out.

A $30 service charge will be applied to your account for all returned checks. If we receive a return check from you we will ask that you pay in cash, money order, MasterCard, Visa or American Express.

A $100 deposit is required for a vasectomy procedure appointment. If you must cancel this appointment, you must call 72 hours prior to your procedure or the deposit is forfeited.

If a child of divorced (or separated) parents is seen in this office, the parent who brings the child in for the visit is responsible for payment of that days services.

Please verify that you have read and understand our Financial Policy by bringing a signed copy of this form to your initial appointment.