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The Doctors Group PC dba Associated Medical Group Financial Policy

For patients with insurance: We bill most insurance carriers for you if a current card is provided to us. We will also bill most secondary insurance companies for you. Co-payments are due at the time of service. Your agreement with your insurance carrier is a private one. We will assist you with your claims within the limits imposed by your insurance company. If an insurance carrier has not paid within 60 days of billing, professional fees are due and payable in full from you.

Medicare patients: We will bill Medicare for you. We will also bill secondary insurance carriers for you.

Medicaid patients: All Medicaid patients must provide a current, valid card before being seen.

HMO patients: All co-pays are due at the time of service. Required authorizations are your responsibility, if no authorization is on file you agree to be responsible for the full balance.

Noncovered services: Any care not paid for by your existing insurance coverage will require payment in full at the time of service or upon notice of insurance claim denial.

Personal injury cases: This office does bill for auto accident related cases. You are responsible to provide our office with all of the claim related details. We do not accept liens.

Worker's compensation: If your injury is work-related, we will need the case number and carrier name prior to your visits in order to bill the worker’s compensation insurance company.

Yearly health checks: Periodic preventive health checks may or may not be covered under your health insurance policy; however, they may be recommended by your physician.

Missed appointments: In fairness to other patients and the doctor, we require at least 24 hours’ notice to cancel appointments. You may be charged $25.00 for missed appointments or dismissed from the practice after three unkept appointments.

Billing charges: If your co-pay is not paid at the time of service there is a $5.00 billing charge.

NSF: All returned checks for non sufficient funds are subject to a $25.00 fee.

Medication refills: There is a $5.00 fee for medications refilled by phone unless monthly refills are required by your physician.

Forms: There is a $20.00 fee for the completion of FMLA forms. The charge for other forms may vary depending on complexity.

MEDICARE PATIENTS - SIGNATURE ON FILE: I request payment of authorized Medicare benefits be made either to me or on my behalf to The Doctors Group PC DBA Associated Medical Group for any services furnished to me by the listed provider/supplier. I authorize any holder of medical information about me to release to the Center for Medicare and Medicaid Services and its agents any information needed to determine these benefits payable to related services.