Advanced Care For Women – FINANCIAL POLICY

We do everything possible to be fair and hold down the cost of medical care. Do not let cost be a barrier to good care, speak to us if you have problems with your bill or charges. The following is a summary of the payment policy.

PAYMENT IS REQUIRED AT THE TIME OF SERVICE

At the time of check in we require a preapproval of $100 on a credit card.

We do not charge your card until after your insurance company has processed your claim and we know your portion of

the payment or copayment.

Patients with an outstanding balance 60 days or more overdue must make payment arrangements prior to scheduling the next appointment. We realize that financial difficulty is a reality and only ask that you let us know if you are having trouble paying your bill so an automatic payment plan can be approved.

INSURANCE COVERAGE:

We file for payment to participating insurance companies as a courtesy to you. If we have not received payment from your insurance company within 60 days of the date of the claim, you are expected to pay the balance in full. You are responsible to be sure all charges are paid whether by you or by your health insurance carrier.

OUT OF NETWORK:

We do not participate in all insurances. We can provide you an up-to-date list on request and if we do not participate in your plan, you will be responsible for payment. You can file for out of network coverage directly with your insurance company.

NON-COVERED SERVICES AND INFERTILITY:

Payment is expected for services provided that are not covered by your insurance, fertility care or if you have no insurance. We will share ahead of time your expected charges. We offer a prompt payment discount you can use for payment at the time of service. We also have financing plans available for large balances.

It is your responsibility to contact your insurance company with questions about your benefits and coverage. We can share our billing summary after we have tried on your behalf for 60 days.

REFERRALS: If you are enrolled in a managed care insurance plan, you must have a referral to be seen at our office. Retroactive referrals are not guaranteed and may make the payment for your consult your responsibility.

ADDITIONAL CHARGES: We send out bloodwork, PAP smears and pathology to affiliated labs for testing. The labs will also file with your insurance, but you may owe the lab for your portion of the charges. We choose nationally recognized low-cost labs covered by most insurances.

MISSED APPOINTMENTS/LATE CANCELLATIONS: Broken appointments represent a cost to us, to you and to other patients who could have been seen in the time set aside for you. Cancellations are requested 24 hours prior to the appointment. We reserve the right to charge for missed or late-canceled appointments. Excessive abuse of scheduled appointments may result in discharge from the practice.

You will be provided a copy of the Financial Policy. You agree to assign insurance benefits whenever necessary. If it becomes necessary to forward your account to a collection agency, in addition to the amount owed, you will be responsible for the fee charged by the collection agency for the costs of collections.

Advanced Care for Women accepts cash, personal checks (in-state only), major credit cards, HSA and FSA payments and Care Credit. Credit card payments are also accepted online via the Patient Portal https://1996.portal.athenahealth.com/ There is a $35 service charge for returned checks.

If you need assistance or have questions, please contact the office by email: billing@DrCoussonsAdvancedCare.com

Or at (920) 888-2828 between 8:00 a.m. and 12 p.m., Monday through Thursday.