Thank you for choosing Pacific Arthritis Care Center to serve the health care needs for you and your family. We are pleased to participate in your health care and look forward to establishing a lasting relationship as your health care provider.
As part of this relationship, we have outlined our expectations for your financial responsibility in our Patient Financial Disclosures document below. Please read the following information thoroughly. Then please print a copy for your records.
Pacific Arthritis Care Center reserves the right to secure a credit card on file for all new patient appointments, on which a no-show fee could be charged in the event that the appointment is not kept.
- It is important that we have your correct address information on file. Please advise us anytime there is any change to your address, email, telephone or other contact information.
Co-payments, Deductibles and Co-Insurance
- Co-payments are collected at the time of check-in.
- Insurance deductibles and fees for services not covered by your insurance policy, if known at the time of the visit, are due at the time the service is rendered. We accept cash, check and most credit cards.
- If you owe additional money after your visit, you can expect a statement. Statements are generated monthly and payment is expected within ten (10) days of receipt of your statement.
Failure to Pay
- Patients who ignore overdue/collection notices and fail to pay their balance risk negative credit ratings and possible dismissal from the practice.
- Past Due accounts may hinder your ability to have appointments scheduled.
- Should your account balance become uncollectible or if you file bankruptcy, we will continue to see you on an emergency basis only for 30 days, giving you time to find a new source of medical care.
- Returned checks are subject to a $25 fee and your account will be placed on a “cash-only basis.” We will accept payments only by cash or credit card until the balance is cleared.
- Failure to give 24 hours cancellation notice or failure to keep your scheduled appointment may result in a charge of $50. Missed appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. We reserve the right to charge a fee for canceled or missed appointments.
- There is a charge for completing forms such as DMV, physical forms, FMLA, leave of absence, disability etc. Most forms require 5 to 7 working days to research your information and complete the form.
- There may be additional charges applied to your account if we are asked to copy medical records or participate in a Deposition or Phone Consultation on your behalf.
- Any patient over the age of 18, or an emancipated minor, is financially responsible for all charges incurred. If another party is responsible for payment of your account, you must pay your balance in full and negotiate repayment with them outside of our office.
- It is important for you to be an informed consumer, who understands the specifications of your insurance policy
- Your health insurance policy is a contract between you and your Health Insurance Company or employer. Please note it is your responsibility to know if your plan’s specific rules or regulations, such as the need for referrals, pre-certifications, pre-authorizations and limits on outpatient charges.
- We request that you be able to present a currently valid insurance card at each visit. We will bill your insurance company directly for medical services rendered. If problems arise regarding coverage issues, we will attempt to work with your insurance company to help resolve them prior to making it your responsibility. You are ultimately financially responsible for payment of medical services rendered beyond your insurance’s plan coverage.
- If you do not present a currently valid insurance card, you may be responsible for payment at the time of your visit. You will receive reimbursement from Pacific Arthritis Care Center if your insurance pays the claim at a later date.
- Pacific Arthritis Care Center contracts with many insurance plans. Before your appointment, please be sure your doctor is in-network and the services to be provided are covered under your plan. If your doctor is out-of-network, you will be responsible for a higher share of the costs, up to potentially 100%.
- If your insurance carrier is not one with which we are contracted, you are responsible for payment in full. You may verify our participation with your insurance plan directly on the plan’s website or by calling our office prior to incurring any costs. Insurance plans and Medicare consider some services to be “non-covered,” in which case you are responsible for payment in full.
- You have a responsibility to provide information to our office so a claim can be properly submitted. If your insurance company has not paid a claim on your behalf within 90 days, the balance will be transferred to your account and you will be responsible for payment. If we receive payment at a later date, you will be reimbursed.
- Please contact your plan to clarify your current health insurance policy benefits and learn the details about your benefits, out-of-pocket fees and coverage limits.
- If we contact your insurance carrier regarding benefits or authorization on your behalf, we are not responsible for inaccurate information provided to us by your carrier. The information about your plan that we relay to you is in good faith.
- Medicare may not cover some of the services that your doctor recommends. You will be informed ahead of time and given an Advanced Beneficiary Notice (ABN) to read and sign. The ABN will help you decide whether you want to receive services and authorize them in writing, to include acknowledging you are responsible for payment in full. You must read the ABN carefully.
Minors and Dependents
- Parent and guardians are responsible for payments for their dependents at the time services are rendered. Minors and dependents must present a currently valid insurance card at each visit.
- The accompanying parent or adult is responsible for full payment at the time of service.
- Payment is due at the time services are provided or upon receipt of a statement from our billing office. Thank you.
Referrals and Authorizations
- Please be aware that a written authorization may be required in order for you to receive care in our office. If we are unable to obtain one from your insurance company, in writing, we regret that we will have to cancel and/or reschedule your appointment.
- A refund is issued when an overpayment has been identified. If you feel a refund is due, please contact our office.
- Self-pay patients should be prepared to pay in full at the time of each visit. If you have any questions regarding fees, please call our business office to speak with a staff member before the visit so we may discuss your specific options.