Return to Policies page Financial Policy of Comprehensive Heart Care, Inc.
Filing Your Insurance
Claims
It
is your choice to see Dr. Roberts, and ultimately your responsibility that
he is reimbursed for the services provided to you at his medical practice.
Our office will file your primary and secondary insurance claims(s)
for you, but to do this we need your completed patient registration
form, and the signed release allowing this office to forward the information
necessary to process the claim to your insurer. Please bring your insurance
card with you to every appointment. If we do not have your current
insurance information, you will be responsible for paying for services
rendered. If our office does not receive payment from your insurance
carrier within ninety days from the date we have filed your claim, the
balance will become your responsibility. Although your have insurance, you
are ultimately responsible for your health care bills.
Paying at the Time of
Service
You
will be required to pay all deductibles, office visit co-pays and
non-covered services at the time of service. All supplements, patches, etc
must be paid for when you pick them up. We will accept telephone or mail
orders to send supplements/ patches to you with valid credit card
information. You will not be able to purchase supplements/patches or
schedule an office visit with Dr. Roberts if there is an outstanding or
unaddressed patient balance on your account. Basically, if you owe us
money, and the amount is clearly defined, you need to pay us before we
provide you with additional services. This is a medical practice, not a
loan institution.
Collection procedures
You
will receive a monthly statement if there is a patient balance due on your
account. If your account balance is not paid within ninety days, collection
action will be taken. Please make every effort to keep your balance current
and in good standing. If special arrangements are required, please speak
with the receptionist. The receptionist will direct you to our Office
Manager who can determine what arrangements are applicable to your
situation. If
your account is transferred to an outside collection agency, you and your
immediate family members will be terminated from care with this practice.
If you are terminated, you will be given a thirty day notice to seek a new
physician.
I understand the above information and agree to comply with this policy.
Patient/Legal Guardian/Parent Signature Date
Relationship to patient (if other than patient has signed) Return to Policies page