Páginas: 6 (1276 palabras) Publicado: 25 de abril de 2012
Patient Financial Policy

Queens Medical Associates has formulated this financial policy that clearly outlines patient and practice financial responsibilities. We are committed to providing our patients with the best care and minimizing administrative costs. This financial policy has been established to avoid any misunderstanding or disagreement concerning payment for professional services.Patient Financial Policies:
• Queens Medical Associates is available to all persons. However, all patients must accept responsibility for payment.
• Patients are required to present a valid insurance card and a driver’s license or picture id upon request at check-in and as needed throughout their care.
o Please notify us if your insurance carrier or policy has changed.
• Ifmedical care is rendered without the appropriate pre-requisites or inaccurate insurance information is presented at the time of the visit, you agree to assume financial responsibility for those services and you may be charged a re-billing fee.

Your Co-Pay:
• If your insurance requires a co-pay, we are required to collect it. Please pay your co-pay when you check in.
• We may reschedule yourappointment if your co-pay is not paid at time of service

Commercial Insurance Carriers:
• If you have a health insurance policy in which we participate our billing office will submit a claim for services rendered. All necessary insurance information, including special forms, must be completed by you prior to leaving the office. We will expect your assistance in contacting your insurancecarrier in the event of non-payment or discounted payments.
• If your insurance plan will only allow you to see physicians that are members of their network, please contact the plan to verify that we do participate.
• If you have insurance in which we do not participate, our office will file a claim upon request. However, payment in full is expected at the time of service.
• It is the patient’sresponsibility to pay any deductible or any portion of the charges as specified by the plan at the time of visit.
• Insurance companies sometimes use the phrase “usual and customary” when discussing physician fees. It is important to note that the insurance companies set their own “usual and customary” rates based on a wide geographical area and the fees we charge may differ. We do not writeoff balances based on this language.
• Our staff is happy to help with insurance questions relating to how a claim was filed, or regarding any additional information the payer might need to process the claim. Specific coverage issues, however, can only be addressed by your insurance company member services or your employer’s Human Relations Department.
• Your insurance company may requireadditional information to process your claim(s) such as accident details, co-ordination of benefits or student status. Your insurance company will request this information in writing. It is very important that you provide your insurance with the information necessary to process your claims. We will allow 10 days to get this information to your insurance company. If, after 10 days your insurancecompany has not received this information from you, the balance will become your responsibility and you will receive a statement for payment in full.
• If your insurance mistakenly sends you our payment, please forward the check immediately. Failure to do so may result in your account being turned over to a collection agency or small claims court. We will notify the IRS as this must be reportedas income.

Worker’s Comp/Auto Insurance:
• Workers compensation laws require the employee to report injuries to their employer. If your care involves a work related injury, we must know the date of onset, location and nature of the accident, and the telephone number of the adjuster for your case. If this information is not provided you are responsible for payment of the entire balance due...
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