Plaza Infectious Disease, PC


Financial Policy

 

We value our relationship with our patients.  To make sure there are no misunderstandings, our office policies regarding financial responsibilities for services provided are outlined below.  Please review these policies and ask us if you have any questions.

OUR RESPONSIBILITIES

  • File primary insurance claims within a timely filing period following the date of service.
  • File secondary insurance claims after the primary insurance payment is received.
  • Provide information to your insurance company as requested.
  • Contact the insurance carrier if the claim is not paid within 45 days after filing.
  • Mail itemized statements to you. 

YOUR RESPONSIBILITIES

  • Present your insurance card(s) and valid Picture ID at the time of check-in to confirm the correct insurance and billing information.  If you do not have your insurance card(s) at the time of check-in, you will be considered a self-pay patient. 
  • Pay co-pays, deductibles, and/or co-insurance at check-in by cash, check, or credit card. 
  • Verify that all requirements of your insurance plan are met.  Two examples of this are: 
    • Confirm with your insurance company that our providers are in network.
    • Find out if approvals are needed for referrals.
  • Respond immediately to insurance company correspondence concerning claims filed by Plaza Infectious Disease, PC on your behalf.
  • Contact your insurance company if your claim has not been paid or if you have not received an explanation of benefits within 45 days. 
  • Pay all charges upon receipt of the initial statement.
  • Call our billing department if you cannot pay your balance in full in 30 days. 
  • Notify us at least 24 hours in advance if you cannot keep your appointment.

ADDITIONAL POLICIES AND INFORMATION

  • A $35 fee will be added to the amount of a check returned regardless of the reason for the return.
  • Any balances over 90 days old may, at our discretion, be turned over to a collection agency.  If that occurs, your account will become a self-pay account, meaning payment must be made at the time of service. 

Financial Agreement:  I, the undersigned, agree to be responsible for the balance of my account.  Although an insurance claim (if applicable) will be filed with my insurance company by Plaza Infectious Disease, PC on my behalf, negotiating payments through my insurance company is ultimately my obligation.  I understand that payment will be made at the time of services rendered unless financial arrangements have been made PRIOR to the services.  A statement will be mailed to me showing the balance due from me and will be considered past due after 30 days.  If I am unable to make payment in full, I understand that I should contact the business office immediately to set up a payment arrangement.  I understand that if no payment has been received or financial arrangements made on my balance, my account may be sent to collections.  If my account is referred for collections, I understand that I will be responsible for the balance as well as any fees associated with the collection process. 

I have received and will abide by the above policies: 

Patient Signature (required) – Draw your signature below using a tablet, mouse or smartphone. By clicking the Submit button I understand and agree that this is a legal representation of my signature.
 
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