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The patient or guarantor will be responsible for all costs of collection including attorney fees, collection fees and contingent fees to collections agencies of not less than 35 percent. Please be aware that if a balance remains unpaid, we will refer your account to a collection agency. Patient payments will not be accepted unless otherwise negotiated with a member of our billing team. Nonpayment: Should your account become 90 days delinquent, you will receive a letter stating that you have 10 days to pay your account in full. The self pay discount does not apply to Co-pays, deductibles, or non covered services. This discount does not apply if insurance is or has been billed. In order for us to offer these rates, payments must be made in full at the time of service before leaving the office.
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Most of our billed charges will be discounted for self- pay patients. Self Pay: We want to provide uninsured patients with quality and affordable healthcare. Patients who have plans that we do participate with are asked to pay their co-payment, coinsurance, deductibles, or non-covered services at the time of their visit. Payment is Required at The time of Service: Patients who are not covered by health insurance, on a plan that we do not participate with, or if we are not able to verify your coverage must pay at the time of service. Your insurance benefit is a contract between you and your insurance company. If payment is denied due to lack of response from you, the balance will immediately become due and payable by you. It is your responsibility to comply with their request. Your insurance company may need you to supply certain information directly. If we are unable to process your claim due to incorrect information given, we will bill you directly for services.Ĭlaims Submission: We will submit your claims and assist you in any way reasonable to help get your claim paid. After that time it will be denied as past timely filing. Insurance carriers give us a 90 day period to submit claims to them for payment.
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Balances left over 90 days will become the responsibility of the patient. It is also your responsibility to notify the office immediately of these changes. We will ask you to update your record at each visit to our office. You will be billed for these services.Ĭhange in insurance plans: You are expected to notify our office if your insurance coverage changes. Non- Covered Services: Please be aware that some- and perhaps all- of the services you receive may be non covered or not considered reasonable or necessary by your insurers. If you fail to provide us with the correct insurance information in a timely manner (48 hours before appt), you will be responsible for the balance of the claim. We must obtain a copy of your driver's license and current valid insurance card to provide proof of insurance. Proof of insurance: All Patients must confirm and/ or complete a patient information form before being seen. Please contact your insurance company with any questions you may have regarding your coverage. Knowing your insurance benefits is your responsibility. You will be required to pay for your visit in full until our office is able to confirm your coverage. If you are covered by a participating plan, but you are either missing an updated insurance card or cannot provide policy and group number, you will be responsible. If you are not insured by a plan, payment in full is expected at each visit. Insurance: SMHWI Participates in most insurance plans, including Medicare. This billing process notification is developed to assist you with understanding your rights and responsibilities when receiving services with SMHWI. We are committed to providing you with quality and affordable healthcare. Thank you for choosing us as your care provider. Social History/Assessment Header Mobile.Michigan Alcoholism Screening Test Header Mobile.Drug Abuse Screening Test Header Mobile.Fillable Nutritional Screening Header Mobile.Authorization To Disclose Header Mobile.Suboxone Treatment In Arizona Header Mobile.Ketamine Treatment In Arizona Header Mobile.Intensive Outpatient Treatment (IOP) Header Mobile.Psychiatric Return to Work Program Header Mobile.Workers’ Compensation Treatment Header Mobile.Psychosomatic Evaluation and Treatment Header Mobile.Substance Abuse Treatment Header Mobile.Outpatient Individual Psychotherapy Header Mobile.General Psychiatric Treatment Header Mobile.New Patient Forms and Resources Header Mobile.