
Financial Policy
Office Visits
We make every effort to keep down the cost of your medical care. Because the billing process has become so expensive and because we all wish to keep medical costs as low as possible, therefore all payments are due at the time of service. We request your insurance information prior to the visit to verify your benefits before the appointment. This is done as a courtesy, and is not required. We do collect all copays and toward deductible and co-insurance, if applicable, at check-in. We do collect a $135 self-pay fee at check-in for new patients and $95 self-pay fee at check-in for established patients. This fee is a deposit for the visit and may not the total amount due. If there are any additional fees or remaining balances based on services rendered during the appointment, we will collect at the end of the visit.
Patients with Medicare or Managed Care pay in accordance with the laws or contracts governing those plans. It is the patient’s responsibility to bring to our office his/her insurance card and insurance information. If your insurance requires a referral authorization to be seen, it is your responsibility to ensure we have received that referral. If you do not have a referral on file, and you wish to be seen, you will be responsible for the fees not covered by your insurance at that visit.
Surgery, ENGs, Allergy Testing, In-Office Imaging
Services requiring larger fees can impose a burden on the financial resources of many people. Therefore, we do accept insurance assignments for these services provided you give us complete, accurate insurance information and we are able to verify your coverage before services are provided. Our Pre-Certification personnel will help you to take care of this. While we are happy to help you receive the maximum benefits allowed by your insurance carrier, bear in mind that it is your responsibility to pay as a deposit any deductible amount, coinsurance or any other balance not paid by your insurance company, prior to receiving services. We also will often require a deposit before surgery, and may require payment to hold your surgery date. Even though we assist you in receiving reimbursement from your insurance company, please understand that you, the patient, ultimately have the final responsibility for your bill. If you have no insurance and need help paying for your services, our Business Office personnel will help you to work out an agreeable payment program.
Insurance Coverage
Liability Actions, Third Party Payers
We do not accept assignment in the case of liability actions. A liability action against someone else is not a reason for delaying payment of your bill. Payment of the bill is the responsibility of the person receiving treatment, not the person being sued who may or may not win the litigation. For these reasons and because lawsuits are often protracted (3 to 5 years), we ask that our bill be paid promptly. We will, of course, furnish your attorney with your medical record provided a signed release accompanies your request.
If you have any questions about our FINANCIAL POLICY or your health care insurance, please call our Business Office at 817-952-5508.
Outstanding Balance
Fees for Forms
Any paperwork to be completed by the physician or physician delegate at the request of the patient can generate a fee which is not covered by insurance. Payment is due at the time forms are dropped off, and is to be collected prior to completion.
- FMLA forms- $25.00 per set of forms
- Disability forms- $75.00 per set of forms
- All other form requests- $10.00 per set of forms
Cancellation Policy
Medical Records
Medical records are handled through an outsourced 3rd party. Please contact Vital Chart at 972-399-0914 to request copies of your records. You can also, contact them directly at www.vitalrecordscontrol.com. Click Request Medical Records.
For CT scans done in office, please contact 817-952-5508 to request a copy. There is a $25 fee for the CT scan disc.
Please note that we have up to 15 days to complete records requests in the State of Texas.
If you have any questions about our FINANCIAL POLICY, please call our Business Office at 817-952-5508. If you have questions regarding your insurance benefits or network providers, please contact your insurance carrier directly.
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