Patient Financial Policy
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In the interest of good communication, we have established this Patient Financial Policy. It is our hope that this policy will facilitate communication between us and help avoid misunderstandings that might arise related to your health care and financial issues. If you have any questions, a member of our Patient Accounts department is happy to discuss the policy with you.

Insurance Cards, Coupons and Photo Identification
Patients must present current insurance verification and photo identification at every appointment.

Collection of Insurance Copayments
Insurance copayments are required at the time of service. Insurance copayments not paid at the time of service may result in the cancellation of the appointment or a surcharge of $15. The $15 surcharge will be considered an integral part of the payment due and the entire amount will be treated as delinquent if it is not paid.

Missed or Cancelled Appointments
Patients that miss or cancel an appointment with less than 24-hour notice are assessed a $25 fee ($75 for procedures).

Returned Checks
Foot and Ankle Clinic assesses a $25 charge for checks that are returned unpaid due to non-sufficient funds (NSF) or because they were written on a closed account.

Forms
Foot and Ankle Clinic will complete forms needed for supplemental health care, disability, family leave, etc. at a charge of $10.00 per form. Charges must be paid at the time of service.

New Patients Without Insurance
Uninsured patients new to Foot and Ankle Clinic are required to make a $125 down payment prior to receiving services. Additional charges may result depending on the nature and scope of services provided.

Established Patients
For accounts in good standing, all charges are due and payable within thirty (30) days unless an extended payment plan is arranged with our Patient Accounts department. To set up an extended payment plan, contact the Patient Accounts department at (213)365-0793 promptly upon receipt of the statement.

If your account has a history of credit problems and you are uninsured or insured by an insurance plan that we are not contracted with, you are required to make a down payment of $125 prior to receiving services. Additional charges may result depending on the nature and scope of services provided.

Surgical Care
Payment of charges for surgical care not covered by insurance (including copayments, coinsurance and deductibles) is required prior to receiving services. Extended payment arrangements are available under special circumstances. Charges for anesthesia, pathology and hospital services are separate and in addition to Foot and Ankle Clinic charges.

Delinquent Accounts
Prompt payment or contacting the Patient Accounts department to set-up a payment plan is required if a past due notice is received. Missed or insufficient payments must be made-up within thirty (30) days in order to continue an extended payment arrangement. Delinquent accounts may be turned over to a collection agency following a 90-day final notice and expiration of a 10-day grace period. Failure to maintain financial accounts in good standing may result in termination of medical care.

Finance Charges
A finance charge of 1% per month or $1.00 whichever is greater, is applied to all balances 85 days from the statement closing date.

If you have any questions regarding this policy, please contact Patient Accounts at (213)365-0793.

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