Patient Financial Responsibility Policy

A Woman’s View firmly believes that a good doctor/patient relationship is based upon understanding and open communication. We hope to avoid any disagreement over payment for professional services by clearly defining our policies at the onset. If you have any questions concerning this policy or need any assistance with your account in the future, please contact us immediately.

• Payment is due at the time of service.  Patients presenting without insurance information are expected to pay services in full at the time of service.
• ALL patients will be asked to put a card on file for ease of payment after insurance has processed your claims.  We recommend an FSA (Flexible Savings Account), HSA (Health Savings Account), or Credit Card.  Debit Cards are also accepted.  If you do not have a card to put on file, estimated patient responsibility will be assessed and collected at the time of your appointment.  Patients will receive a notification 5 days prior to any amount taken. Please review the Card on File Frequently Asked Questions for additional information, or call our office to speak with a staff member.
• You will be asked for your insurance card at each visit.  Failure to provide valid proof of insurance will require us to collect on your services for that day in full prior to your appointment.
• All insurance co-payments, co-insurance or deductibles are due and payable at the time of service.  This is in accordance with federal regulations.
• If provided insurance information, we will file claims with your insurance carrier. Once your insurance has processed your claim, you are responsible for any balance due.  Credit Card on file will be charged for ONLY the amount insurance applies to patient responsibility.  Patients are responsible for calling our office prior to a deduction being taken if there is a dispute with the charges applied by their insurance company. We will then put charges on hold until the dispute can be resolved.
• Your insurance coverage is an agreement between you and your insurer. If your carrier fails to remit payment for your account, you will be responsible for contacting your insurance carrier.
• You are encouraged to contact your carrier prior to services to ensure you understand what your plan guidelines will cover for your visit.
• Accepted methods of payment include:  Visa, MasterCard, Discover, American Express, check, or cash in payment for services. There is a $35 service charge for checks that are returned.
• If it is necessary for you to undergo surgery or a procedure, we will help you determine which services your insurance company will cover and which fees will be your responsibility. Deposit and payment arrangements will be discussed and set up prior to your surgery or procedure.
• A $25 “no show’ fee will be applied for failure to keep an appointment OR provide at least 24 hrs cancellation notice.

Failure to adhere to the above policies could result in your account being turned over to an outside collection agency. Fees applied by the collection agency will be added to your balance and become your responsibility.

Request for Forms

• Medical Records are available upon request and subject to an administration fee of up to $35. This fee will be payable in advance, for you to receive a copy of your medical records. This fee may be waived if your records are sent directly to another physician or for records sent to your insurance company.
• Forms (i.e. physical forms) brought for completion outside of a scheduled appointment will be charged an administration fee, payable in advance, of $10. Disability forms or other forms with 2 or more pages will be charged $25.  We request that all forms be brought in at one time to keep charges at a minimum.