FORD-TEL MEDICAL CENTER FINANCIAL POLICY
You are financially responsible for the
services we provide to you. IT IS YOUR RESPONSIBILITY
TO UNDERSTAND YOUR INDIVIDUAL INSURANCE COVERAGE PRIOR TO
SEEKING OUR MEDICAL SERVICES.
We will file a claim with your insurance
company. However, the patient is responsible for the bill
if insurance company does not pay. We require payment for
service not covered by insurance plans and co-payments at
the time of the service.
Patients without insurance
Patients will be requested to make full
payment for the office visits at the time of service.
For immunizations or minor surgical procedures the full
amount must be paid before the services are rendered.
We accept Medicare assignments.
We will bill your secondary insurance if you provide us
with proper insurance information. You are responsible
for coinsurance and deductible, and charges for not covered
services. You will also receive an explanation from
Medicare indicating how much you owe.
Private insurance patients
We accept assignments for most insurance
companies. You will be required to pay co-payment as well
as coinsurance, deductibles and price of non-covered services
at the time of the service. Please be informed that
Medicare and private party payers forbid altering the fee
schedule. Please, do not ask us to waive your co-payment
You must be assigned to one of our physicians
at the time of the service. If you are assigned to
a physician at another location, you will be expected to
sign a waiver and take full responsibility for the payment.
Preparation of the forms for Disability
or other documents
There is a charge of $15 for each form.
There is no fee if appointment is scheduled to complete
Charges for medical records
Upon execution of the appropriate authorization
we will prepare the copies of your medical records for $0.25
Methods of payments
We accept cash, check, Visa, and Master
Card. There is a $25 fee for returned check.
Patients with prior balances must pay
in full before seeing a physician.
Collection procedures /Payment arrangements
Payment by the patient is a responsibility
of patient in a patient-physician relationship. Prompt payment
for the services is expected. Failure to comply or
respond to communication from our billing company may result
in discharge form the practice and / or involvement of an
outside collection company.