All professional services rendered are charged to the patient. Necessary forms will be completed to help expedite insurance carrier payment; however, the patient is ultimately responsible for all fees charged for services rendered regardless of insurance coverage. It is also customary to pay for services when rendered unless other arrangement have been made in advance with our office. If hospitalization is indicated, the patient is responsible for furnishing insurance claims to be office prior to hospiralization.
Pre-certification or Pre-authorization for Care
Many insurance policies and managed care plans require pre-certification from the carrier or advance authorizations from the patient's Primary Care Physician. When such pre-certification or pre-authorization is not obtained when non-emergency care is sought, the insurance policy or managed care plan may provide no or dramatically reduced benefits. Our office staff will assist you to the extend possible to secure such pre-certification or pre-authorization. Ultimately, it is the patient's responsibility to secure such pre-certification or pre-authorization under the terms and conditions of their insurance policy or managed care plan.
Truth In Lending Agreement & Assignment of Benefits
This date, I have contracted with Cardiovascular Diagnostic Center, APMC- Virginia Y. Gonzalez, M.D., for the furnishing of medical or surgical procedures for illness or injury. I will be responsible for payment of the total bill incurred as a result of treatment received. Although I may choose to use insurance coverage to pay all or a portion of the bill incurred, I understand that the filing of insurance claims does not constitute payment of any portion of the bill and I understand that I am responsible for all charges billed to me for treatment. I accept full responsibility for payment of the total balance of my account. When the account becomes 90 days old, or after all insurance has been paid, a monthly finance charge of 1% will be applied to the remaining balance. I have this date assigned to Cardiovascular Diagnostic Center, APMC- Virginia Y. Gonzalez, M.D., the benefits due to me under my existing policy or policies of insurance. is accepted by Cardiovascular Diagnostic Center, APMC- Virginia Y. Gonzalez, M.D., as convenience to me and Cardiovascular Diagnostic Center, APMC- Virginia Y. Gonzalez, M.D., is hereby given my consent to file claims on said policy or policies and do such other actions as it deems necessary in connection therewith so as to obtain prompt payment under such policies. I authorize my insurance company to pay Cardiovascular Diagnostic Center, APMC- Virginia Y. Gonzalez, M.D., direct without payment to me.