Patient Regristration Guidelines
1. Patients will be seen by appointment only.
2. The patient is required to complete and sign a Registration Form annually and at any time there is a change in his/her address or insurance information.
One out of twenty patients provides invalid / incorrect insurance information that ultimately leads to an insurance denial and an unnecessarily large bill that becomes the patient's responsibility.
Please inform the receptionist of any changes immediately!
3. The patient is required to supply a valid medical insurance card with the Registration Form and upon check-in at every visit.
4. The patient is ultimately liable for all charges on her account.
5. Copays are due at registration without exception.
Please understand, it is against the law for a physician to write-off or adjust the copay. By failing to collect these fees, the physician is in violation of the law.
A $30.00 surcharge will be added to those who demand to see their provider without their copay.
6. No insurance carrier will be billed for office visit copays.
7. Acceptable methods of payment are: CASH, CHECK, and VISA/MASTERCARD.
8. A $30.00 fee will be charged to the patient's account for any personal checks returned NSF.
9. If a valid insurance card is provided, the patient's insurance carrier will be billed as a courtesy.
10. In the event of two insurance carriers, the higher of two fee schedules will be applied.
11. The patient is responsible for knowing what services are covered by her insurance and which providers participate in her insurance plans and networks.
If a patient is seen as an out of network visit, they are responsible for all charges incurred or denied by their insurer.
12. A $50.00 fee will be charged for a "no-show" without prior cancellation within a 48 hour time period.
For questions regarding converage benefits and limitations of your insurance policy please refer to the number for the customer service department listed on the back or your insurance card.
For billing questions please contact our billing office:
NCDS - Medical Billing Systems
1(800)556-6236 - http://www.billing@ncdsinc.com
THANK YOU VERY MUCH - YOUR COOPERATION IS GREATLY APPRECIATED.
