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• OUR DOCTORS • NEW
PATIENT FORMS • FINANCIAL POLICY
• LOCATION Women's Health Alliance Financial Policy 1. All charges incurred for services in the office will be payable at the time of service unless other arrangements are made. 2. All co-payments are due before service is provided 3. There will be a $25.00 service charge on all returned checks. 4. The deductible and co-pay may be required in advance for all surgeries. All elective procedures, not covered by insurance must be paid in full prior to the surgery unless other arrangements are made. 5. All OB patients are required to pay any portion of the delivery fee not covered by insurance by the first of the sixth month. OB patients are also required to promptly pay for any other services provided during the pregnancy. Care may be discontinued at any time for noncompliance. 6. All contraceptive devices furnished at the office are to be paid at the time service is provided. 7. Patients needing services due to an injury which involves a third party will be responsible for their own account. As a courtesy, we will be glad to file insurance for you. 8. The responsibility for payment of service lies with the person seeking treatment or the person seeking treatment for another. Any court-ordered responsibility judgment must be determined between the individuals involved without the inclusion of our office. 9. All patients seeking infertility services must furnish a statement from their insurance company regarding infertility benefits before service is rendered. All services not covered by insurance must be paid at the time of service. 10. All patients having insurance requiring a referral for OB/GYN services will be required to present the referral before services are provided. Any patient seeking service without a referral must pay for the service in advance or reschedule the appointment. 11. Women's Health Alliance physicians may discontinue care for any patient due to nonpayment. 12. Any patient's account that cannot be collected by our office will be turned over to a collection agency. In this event, payment in full will be required for any future services, regardless of insurance coverage. Also, you will be responsible for any court costs, attorney fees, etc., incurred by the agency to collect your account. HOME
• OUR DOCTORS • NEW
PATIENT FORMS • FINANCIAL POLICY
• LOCATION Summit
Women's Group |
