FINANCIAL POLICY

Effective July 1, 2015

Thank you for choosing CHRISTINE COLLINS, MD & ANN HOFSTADTER, MD for your gynecologic care. Our doctors and staff are dedicated to serving your medical needs with the best professional advice, care and service. Please understand that whether or not you have insurance, payment of your bill is your responsibility. The following is a statement of our Financial Policy:

 

 PRIVATE PAY PATIENTS

 For patients without insurance coverage or insurance that cannot be verified, payment is due at the time of the service. We accept cash, checks, and most major credit cards.

 

 INSURANCE PLANS

 We must have a current insurance card to submit a claim to your insurance company. If you do not have a current insurance card, full payment is due at the time of service. It is your responsibility to notify us in a timely manner of any changes in your insurance coverage or personal data information. Please do not assume that we know if your insurance has changed. Additional fees will be charged if we are provided incorrect or outdated information.

 It is your responsibility to verify whether a physician in this practice has a contract with your insurance company prior to making an appointment. WE DO NOT ACCEPT COVERED CALIFORNIA.  It’s in your best interest to CHECK YOUR POLICY CAREFULLY.  If you arrive for your appointment without the appropriate coverage, you will be asked to pay for your visit on the day of your appointment. If you choose to leave without being seen, you will be charged a no-show fee for the appointment time saved for you.  See below for no-show fees.

 We will bill your insurance carrier for all covered services. You are required to pay for all co-payments, deductibles and coinsurance at the time of your visit. Please be aware that your insurance company may consider some, or perhaps all, of the services provided to be non-covered services and refuse to pay for such services or might determine that such services are subject to a deductible in addition to your co-pay. If additional payment is due after your visit charges have been reconciled with any insurance payment, you will receive a statement from our billing department.  Any balance on your account for services not covered by your insurance will be your responsibility and is payable upon receipt. Please understand that our insurance contracts specifically forbid discounting co-payments or deductibles.

 

 MEDICARE

 As Non-Participating Providers for patients covered by Medicare, payment in accordance with Medicare’s limiting charges is required when services are rendered.  We will bill Medicare for you, and you will be reimbursed directly by Medicare and any supplemental insurance you may have.

 

FERTILITY TREATMENT

 Your insurance carrier may not cover fertility treatment or evaluation. We may require payment at time of service.

 

 PROCEDURES AND LABORATORY CHARGES

 If you have a co-pay it must be paid at each visit and there are no exceptions. We do not waive or reduce co-pays or other patient obligations under any circumstances, as it is a violation of our contract with your insurance company. We charge a collection fee for all blood draws. You may choose to go to an outside laboratory for your blood draw.  Charges for any lab fees are never included in our fees for services.  The lab always bills laboratory fees separately.

 

 MEDICAL NECESSITY

Keep in mind that care your doctor believes is medically necessary may not be considered to be a “medical necessity” under your insurance plan or a covered medical benefit under your plan. In some cases, your doctor might decide that you need medical care that is not covered by your insurance policy.

 

 BILLING AND COLLECTIONS POLICY

 If you carry an outstanding balance in excess of 60 days after your first billing, that balance will be charged to your credit card on file.  If your credit card information is not valid and we do not receive valid card information from you, your account will automatically be forwarded to a collection agency for further action. Any accounts forwarded to the collection agency become the property of the collection agency and are subject to additional fees as allowed by law. Any unpaid balance that is sent to a collection agency becomes the property of the collection agency and under no circumstances can any reduction be made.

 If you wish to contest a particular charge, you will have 30 days after your first billing statement is received. After this time period all charges are considered final and no further modifications are possible.

 

 MISSED AND LATE APPOINTMENTS

 If you are unable to keep an appointment, we ask that you kindly provide us with at least 24 hours’ notice. If 24 hours’ notice is not given, a $100 fee will be assessed to your account.  New patients who no-show will be charged $250.  In addition to signing an acknowledgement of receipt of this Financial Policy, we require that you provide a valid credit card.  In order to schedule another appointment after a no-show, we will be charging the no-show fee as indicated.  No-shows will not be rescheduled until the no-show charge has been paid.

If you are late for your appointment, we will make an attempt to accommodate you but cannot guarantee that we will be able to see you.  You may have to wait or your appointment may need to be rescheduled for another day.

 

 MEDICAL RECORDS

If you should need copies of your records, California law allows us to charge a fee for these services. The law also allows us fifteen working days to process the request. Legally we may choose to provide a records summary as opposed to a copy of the complete medical record.

 Medical records fees:

  • Initial fee: $4.00
  • First four pages: no charge
  • Each additional page: $0.25

 

 ADDITIONAL FEES

 We reserve the right to impose additional convenience charges which are not covered by insurance and which you will be advised upon in advance.

 Other Fees:

  • Re-billing Fee (when original billing is submitted with incorrect or outdated insurance information)
  • Billing secondary or other insurance with special or non-standard forms
  • Accessing old medical records from storage
  • Completion of special reports or forms not usually part of an office visit (e.g., disability, school or work forms)
  • Communications with other agencies
  • Special requests for insurance authorizations for procedures unlikely to be covered
  • Supplies and/or medications provided for convenience typically obtained at the pharmacy

 

We sincerely thank you for taking the time to read and understand our Financial Policy. Please ask our staff if you have questions or concerns, or you may call 310-273-3230  to speak to an office staff member.