If you are unable to keep your appointment, please call us as soon as possible so that we may make your time available to other patients. For your convenience, you may cancel by calling us directly during regular business hours at (435) 613-2200, or you may leave a message on our cancellation line 24 hours a day, seven days a week at (435) 613-2204. You may also cancel by sending us a message through our patient portal.
If you are unable to give us notice of at least two hours that you would like to cancel your appointment, you will be charged a missed appointment fee of $50.00. The missed appointment fee must be paid before scheduling another appointment.
Payments – Effective January 1st, 2016
Charges are payable at the time treatment or service is given. Regardless of your medical insurance coverage, our office relies on you to settle your account. As of January 1, 2016, all patients will be required to either set up one of our automatic payment methods or pay the full estimated amount for their visit at check-in. We will no longer offer the option of charging balances to individual patient accounts.
For your convenience, we offer the following payment options:
- If you have insurance, we require that you pay your estimated portion at the time of service (i.e. co-pay, co-insurance, or deductible.) We also require that you set-up an automatic payment method for any additional balance due after the charges are processed according to your insurance contract. We now offer the following automatic payment options:
Credit Card on File: You may now securely leave a credit card on file to pay for any additional amounts left as your responsibility by your insurance company. We will charge your card for the exact amount left as your responsibility by your insurance company. This is similar to leaving a credit card on file for incidental room charges at a hotel.
Greenlight: You may now securely leave a credit card authorization on file for today’s visit only. We will finalize the authorization for the exact amount left as your responsibility by your insurance company. This is also similar to leaving a credit card on file for incidental room charges at a hotel.
Cash / Check: If you prefer, you may pay an estimated amount for today’s visit by cash or check. We will refund or bill you for any difference between the amounts collected today and the exact amount left as your responsibility by your insurance company.
- If you have a primary and secondary insurance we will bill both of the insurance companies before charging your card for any remaining balance. We will only bill two insurance companies. If you have additional insurance it is your responsibility to bill them.
- If you do not have insurance, we require that you pay for the visit in full at the time of service. We accept cash, checks, MasterCard and Visa.
We cannot and do not guarantee our services will be paid by your insurance company. If the insurance company denies payment you are responsible to pay us directly for all services provided. You are responsible to pay all charges and fees incurred as shown by our statement unless payment arrangements are agreed upon in writing. Charges shown by our statements are deemed to be correct and reasonable unless protested in writing within thirty days of the billing date. If this accounts becomes deliquent you will be responsible to pay all court costs, attorney’s fees and collection agency commissions incurred in collecting this account, and understand that collection agency commissions might be as much as 50% of the principal balance owing. Insurance regulations require that you pay your co-pay or co-insurance at the time of service. I understand that in order to receive a bill for your co-pay or co-insurance, you will be charged a billing fee of $20.00.
Our business office will submit primary and secondary insurance claims for you subject to your having given us current insurance information prior to the service being provided. Policy coverage varies from one insurance plan to another, as do the “usual, customary and reasonable” fees that various insurance plans have established. Our fees are accepted by most plans, but occasionally one of our patients is notified that the amount for our services exceeds “UCR FEES”. Our contractual arrangement is with you, our patients, not your insurance company. Should there be a dispute related to the service provided or the charge for that service, please settle that dispute with your insurance carrier. Our office is not involved in the settlement of such disputes. The final responsibility for the services provided to you is yours. Insurance cards must be received in our office within 30 days of the date of service. We will not accept an insurance card after that time.