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Financial Policies

We would like to thank you for choosing IHP Medical Group as your medical provider. We have written this policy to keep you informed of our current financial policies. Please read this policy statement thoroughly and sign your acknowledgement below:

No Insurance: Payment will be due at the time of service. If you are unable to pay your balance in full, you will need to make prior arrangements with our patient accounts staff. A deposit of $200.00 may be required at the time of service.

Insurance: Although we are contracted with several insurance companies, it is your responsibility to make sure that our physician is in your plan. It is also your responsibility to know your insurance benefits. As a courtesy to our patients we will file primary insurance forms from our office. In order to do this we will require information from you. We will need all your demographic and insurance information prior to your appointment. We will also request an update on this information approximately every six months thereafter. We ask that at the time of your appointment you bring your insurance card and a photo ID as well as any other forms that will assist in making sure that your claim is filed correctly. At the time of service you will be responsible for all fees that are not covered by your insurance, including co-pays, co-insurance, deductibles and non-covered services or items received. The co-pay cannot be waived by our practice, as it is a requirement placed on you by your insurance carrier. We strive to be as accurate as possible in calculating your responsibility but, with so many variations in policies and fee schedules, we are not always exact. You may receive a statement from our office for any balance due. For your convenience we accept cash, checks, credit cards (Visa, MasterCard, and Discover), and money orders. Payments are also accepted by phone.

Auto Accident: If your injury is a result of an auto accident, please inform the receptionist and/or a patient services representative immediately. You will need to supply the receptionist with the carrier and claim information.

Liability Injury: If your injury is a result from another party’s negligence, you are required to pay for services and then collect from the responsible party. We will bill the insurance as a courtesy, however you are ultimately responsible for the payment within a timely manner.

Worker’s Compensation: If your injury is due to an accident in your work place, please inform the receptionist and/or patient services representative immediately. You will need to supply the receptionist with the carrier and claim information.

Disability, Insurance Forms, Attending Physician Statements, FMLA: There may be a charge of $5.00-$25.00 for the completion of medical forms depending on the length of the form. In some instances you may be required to schedule an appointment. Payment is due at the time that you pick-up these forms. Please allow 7-10 days for the completion of these forms. If you would like the forms mailed to you or the insurance, payment will be due prior to mailing. FMLA forms require that you come in for an appointment.

Medical Records: We will provide you a copy of your medical records upon request and for a fee. You will need to sign a letter of release prior to having them copied. Please allow up to 10 days for this request to be processed. A minimal fee of 75 cents per page will be charged to cover the cost of the copies. Payment is expected at the time of pick-up.

Billing: If you receive a bill from us, it is because we believe the balance is your responsibility. Please contact your insurance company first, if you think there is a problem. If you have any questions about your bill, please call our billing department immediately. If you cannot pay your entire balance, please call to make payment arrangements.

Collections: Accounts that are not paid within 30 days begin our in house collection process. If your balance becomes 65 days old, a late fee of $10.00 will be added to your account, final notice will be sent and the account may be placed with an outside collection agency. In addition, your doctor will be notified and you may be subject to dismissal from the practice.

Missed Appointments: There will be a $25.00 fee if you scheduled an appointment and failed to show up without providing at least a 24 hour advance notice of the cancellation. IHP will send a billing statement to you for $25.00 which must be paid within 15 days of receipt or before your next appointment and/or before scheduling another appointment with IHP.