Our priority is to provide exceptional medical care to our
We value our relationship with you. Please
read this financial policy carefully to prevent
misunderstandings. Thank you.
It is your responsibility to keep the practice updated
with your most current information (insurance, address,
phone numbers, emergency contacts, etc).
Any questions regarding
benefit issues or physician participation status should
be directed to your insurance company. We will
help with what we can but we don’t know each contract
and its benefits
We expect any copay to be
paid at the time of service. If payment is not made at
the time of the service a $10
administrative fee will be added to your account.
It is part of your contract with your insurance for you
to pay your copay at the time of service
We are collecting partial
payment for the high deductible insurances at the
time of your visit. We will bill you for any remaining
balance after your insurance processes your claim. We
make every effort possible to determine what is allowed
by your insurance. We realize there could be a conflict
with your HSA or FSA account if an overpayment is made.
Please be aware of your deductible
We will file a claim on your behalf to all insurers with
whom we are currently participating. If we are not
participating with your insurer, you are responsible for
paying in full at the time of service.
We do not participate with
all insurers so please check with your insurance to
verify that you are covered here. Some insurers
require you to list a Primary Care
Physician (PCP). Please make sure one of our doctors is
listed so they will pay for your visit here.
Many offices do not bill a secondary insurance company,
but we will bill most
secondary insurances as a courtesy to our
patients. Please make certain you have all your current
insurance information available at check in so we are
able to provide this service. We will not submit for a
copay in many instances.
We will submit for motor vehicle accident (MVA) claims
but we do not submit
for Workers’ Compensation or any liability claims. We
do not treat workers’ compensation injuries, therefore,
we refer you out to someone who does
There is an administrative charge
of $15 for the completion of forms that require a
provider to review your chart and sign the form. This
fee is waived if the form is presented at the time of a
Returned checks will incur a $20
returned check fee. In the event of a second
returned check, your privilege to pay by check on future
visits will be terminated and you will be expected to
pay with cash or credit card.
We require prior
notification (minimum of 4 hours) if you are unable to
keep your appointment. There will be a
charge for all missed appointments.
Chronic missed appointments could result in termination
It is understood and agreed that in the event any
outstanding balance has to be referred to a collection
agency or attorney for recovery, the patient will be
fully responsible for any cost, including, but not
limited to attorney’s fees. If there is no response to
our continued efforts to reach the patient by phone or
mail the patient will be told to seek medical care
elsewhere. We work very hard to help you keep this from
happening. Please keep in touch with us if there is a
We require that you sign a payment
plan agreement if you are unable to pay the entire
balance on your account by the due date. The amount
paid each month will be determined by Hilton Health Care
and must be paid in addition to any additional charges
each month. It is your responsibility to make the
monthly payment on time without additional reminders.