Thank you for choosing Pondville Medical Associates as your care provider. We are committed to building a successful physician-patient relationship with you and your family. Your clear understanding of our Patient Financial Policy is important to our professional relationship. Please understand that payment for services is a part of that relationship. Please ask if you have any questions about our fees, our policies, or your responsibilities. It is your responsibility to notify our office of any patient information changes (i.e. address, name, insurance information, etc).
co-pays
The patient is expected to present an insurance card at each visit. All co-payments and past due balances are due at time of check-in unless previous arrangements have been made with a billing coordinator. We accept cash, checks and credit cards including Visa, Mastercard, American Express, Discover and others.
participating insurances
Pondville participates with many insurance plans. In order to properly bill your insurance company we require that you disclose all insurance information including primary and secondary insurance, as well as, any change of insurance information. Failure to provide complete insurance information may result in patient responsibility for the entire bill. Your insurance company that makes the final determination of your eligibility and benefits. If your insurance company is not contracted with us, payment in full is expected at the time of your visit.
referrals and pre-authorizations
If your insurance company requires a referral and/or pre-authorization, you are responsible for obtaining it. Failure to obtain the referral and/or pre-authorization may result in a lower or no payment from the insurance company, and the balance will be your responsibility.
pre-certification
Prior approval may be required by your health plan before certain procedures, tests or surgeries are performed. We will assist you in the pre-certification process by contacting your insurance company on your behalf. Be sure to confirm that you have been granted pre-certification status prior to your procedure so you do not incur any unnecessary personal charges.
patients without insurance
Payment in full is expected at the time of your visit for patients without insurance coverage and patients covered by insurance plans with which the office does not participate . It is always the patient’s responsibility to know if our office is participating with their plan. If there is a discrepancy with our information, the patient will be considered self-pay unless otherwise proven. Extended payment arrangements are available if needed. Please ask to speak with an administrator to discuss a mutually agreeable payment plan. It is never our intention to cause hardship to our patients, only to provide them with the best care possible and the least amount of stress.
workers’ compensation and automobile accidents
You must already be a patient of our practice. In the case of a workers’ compensation injury or automobile accident, you must obtain the claim number, phone number, contact person, and name and address of the insurance carrier prior to your visit. If this information is not provided, you will be asked to either reschedule your appointment or pay for your visit at the time of service.
returned checks
The charge for a returned check is $25 payable by cash or money order. This will be applied to your account in addition to the insufficient funds amount.
medical record copies
Fees for patients requesting copies of their records are consistent with fees approved by the Massachusetts Board of Registration in Medicine.
minors
The parent(s) or guardian(s) is responsible for full payment and will receive the billing statements. A signed release to treat may be required for unaccompanied minors.
outstanding balance policy
It is our office policy that all past due accounts be sent three statements. If payment is not made on this account, a single phone call may be made to make payment arrangements. If no resolution can be made, the account will be sent to the collection agency, or attorney, and possible discharge from the practice.
In the event an account is turned over for collections, the person financially responsible for the account will be responsible for all collections costs including attorney fees and court costs.
Regardless of any personal arrangements that a patient might have outside of our office, if you are over 18 years of age and receiving treatment, you are ultimately responsible for payment of the service. Our office will not bill any other personal party.
This financial policy helps the office provide quality care to our valued patients. If you have any questions or need clarification of any of the above policies, please feel free to contact us.
