NOTICE OF FINANCIAL RESPONSIBILITY AND PAYMENT POLICY

Accepted Payment Methods

We accept all major credit cards (Visa, MasterCard, Discover and American Express), as well as personal checks and cash. Receipts will be made available to you for all payments
 

Cancellation and no-show policy

If you must cancel or reschedule your appointment, we ask that you please contact our office at least 24 hours prior to your appointment time or on Friday for any Monday appointments. A no-show fee will be assessed to the patient’s account if 24 hours (or on Friday for a Monday appointment) is not provided for cancellation or if an appointment is missed with no notification. Multiple no shows or same-day cancellations will result in higher no-show charges for each missed appointment and may result in dismissal from the practice.

There is a $25 charge for a FIRST missed appointment  with our office.

There is a $50 charge for a  SECOND missed appointment . If a second appointment  is missed the appointment will not be rescheduled.

If a third appointment is missed, the patient may be considered noncompliant with follow up, which may result in dismissal from the practice.

NO SHOW POLICY IS FOR IN PERSON SELFPAY AND INSURANCE PATIENTS NO EXCEPTION.

Self-Pay Services

You are responsible for the payment due prior to services being rendered  based on the price of the service.

Insurances Eligible Services

We accept many commercial insurances and state-supported plans; however, it is your responsibility for confirming your eligibility, plan benefits, and any required co-insurance, deductible, and/or co-pay prior to each appointment.

You will be asked to provide your insurance information at the time of scheduling your first appointment, and our staff will utilize this information to verify your insurance eligibility. If the insurance carrier reports that you are ineligible for coverage, or if we are unable to verify your eligibility, we are obligated to collect full payment before you can be seen by a provider. Please refer to the Payments section below for more information.

Please be sure to notify our office immediately of any changes in insurance carrier, plan benefits, and/or co-pay amount.

Please be aware that we cannot advise you on whether any particular service, whether rendered at LenoyMED  will be covered by your insurance carrier, nor can we estimate any out-of-pocket cost to you. We strongly encourage you to contact your insurance to confirm your plan benefits prior to obtaining any services, as you are financially responsible for any charges not covered and for submitting payment directly to the rendering facility.

Our office is happy to provide you with a superbill documenting your payment and the necessary documentation of your  medical care if you would like to pursue out-of-network reimbursement with your insurance carrier. However, please note that we cannot guarantee approval of your reimbursement claim, and our office makes no warranty regarding any particular insurance carrier’s policies on out-of-network coverage. As with all insurance matters, we strongly encourage you to contact your insurance carrier directly for guidance.

Two special Situations

Medicare Patients:

Medicare may not cover some services which  physician believe are necessary for your treatment, or services which are not considered medically necessary, but which may be requested to be performed anyway. These services include, but are not limited to: Preoperative examinations, vaccinations, EKG etc.

Should Medicare deny payment for services considered "routine" or not "medically necessary”, you understand that you will be personally responsible for the payment. This agreement is made freely and is allowable under the terms of Medicare’s current regulation.

     2. High Deductible Plan:

If you have high deductible plan you have to pay upfront before provider can see. Then we will submit claims to insurance on your behalf and based on the approval we will adjust the amount paid. If you cannot pay upfront, then you have to provide us valid unexpired credit card which we can charge once insurance EOB is available for the visit.

Co-Pays

You are responsible for any co-pays due prior to services being rendered. If your insurance card does not specify a co-pay amount, but a billed claim is left with a balance for an unpaid co-pay, we will request immediate payment of that balance and will proactively collect that amount at future visits.
 

Balances Due

Your insurance policy is a contract between you and your insurance carrier, and while our office is happy to submit billing claims on your behalf, we cannot be responsible for the insurance carrier’s ultimate determination of your coverage and benefits.

Following your appointment, our office will submit a claim to your insurance. Should any portion of a billed claim be left unpaid by your insurance carrier (whether due to ineligibility, denial of the claim, non-covered services, or deductibles not met), you as the guarantor are liable for that balance, which will be billed to you. Fees for last-minute appointment cancellations or “no-shows,” as explained in our Office Policies, will also be billed to you. Payment for any billed amount must be submitted by the due date stated on the bill itself. Any balances left to patient responsibility are expected to be paid within 30 days of receipt of the first account statement for that balance. After the first statement a rebill fee of $5 will apply to each statement sent. Past due balances will incur an account-maintenance fee once the balance is 30 days past due. After 60 days past due this new balance as well as any no-show fees will be forwarded to an outside collection agency. All additional costs incurred due to the delinquency of the account are the patient’s responsibility. These costs may include billing fees, collection agency cost, which may exceed 50 percent of the balance, and/or attorney fees if applicable. The patient must then contact the agency rather than the office for any further payment arrangements.

Patients who provide checks with insufficient funds will incur a fee of $35 and will no longer be permitted to pay by personal check.

Selection of Laboratory and other diagnostic service provider

Please be aware that, as part of your diagnosis and/or treatment, your provider may recommend laboratory testing, imaging studies, or other procedures. You acknowledge and accept that it is ultimately your  responsibility to be aware of the benefits available under your insurance plan and understand that If have any special request regarding facilities to be utilized for Diagnostic test/ treatment then you will Communicate those at the time of your  visit.