Patient Financial Responsibility

Your health insurance is based upon a contract between the insured party’s employer and the insurance company, or between the parent/guardian of the child, and the insurance company. The insurance company has the responsibility to provide supporting documentation (Plan Benefit Booklet and Enrollment Card(s)) to the insured. The insured party and any adult who benefits from the insurance plan, or whose child receives benefits from this plan, is responsible for the following information: the commencement and expiration date of the policy; the annual deductible, if applicable; the coverage of well visits and immunizations; if a provider, lab, imaging facility and/or hospital is contracted with the insurance company; the amount of your co-pay; pharmacy benefits. Many insurance companies have additional stipulations that may affect your coverage. The insured party is responsible for any amounts not covered by the insurer within 30 days of statement delivery. Late payments are subject to an additional late fee. If your insurance carrier denies any part of your claim, or if you or your physician elects to continue past your approved period, you will be responsible for your balance in full. We DO NOT bill secondary insurance.