Copayments & Other Fees

  • Effective Sept 1, 2014, we will no longer accept personal checks
  • Copays- As participating providers with your insurance plan, it is required to collect your copayment on the date of service. If payment is not received at the time of visit, you must call in and make payment prior to the end of day. If we do not receive payment by the end of the day, a $10 late fee will be applied.
  • Uninsured-If you have no insurance coverage, payment is due at the time services are rendered. A credit card will need to be kept on file.
  • After Hour Calls- As of May 1st, 2017 a $15.00 fee will be incurred for after hour calls
  • No Show Fee-Failure to cancel your appointment within 24 hour notice will result in a $25.00 charge
  • Nurse Visit- A $20.00 charge will be incurred for nurse visits
  • Forms- A $10 charge will be incurred for all forms and letters that require more than a signature. These are often lengthy and take extra time to be completed. Please all up to 4 business days for these to be completed.
  • Late Fee-If payment is not received in a timely manner, your account will be billed a $25 late fee per monthly billing cycle. After three (3) billing cycles your account will be turned over to a collection agency and you will be responsible for all service fees.
  • Returned Checked- $35 will be charged for any checks that are returned NSF.
  • As the guarantor, you are responsible for all remaining balances after the insurance has paid. This includes coinsurance, deductibles, and non-covered services.
  • Payments on any outstanding patient balances are due at time of visit.
  • If the patient is a minor (anyone under the age of 18) a parent or legal guardian must be in attendance to give consent for treatment and be the responsible guarantor.
  • In a divorce situation, the parent who brings the dependent child to our office is responsible for payment. Insurance may be filed, but the parent in attendance will be responsible for any copayment or outstanding balances.