Cole Surgical Arts participates with most insurance plans. However, each insurance policy is different, and it is difficult to know benefit details for all carriers. Contact your insurance company if you have any questions regarding benefits and payment obligations.
Copayments and Deductibles
All co-payments, co-insurance, and deductible amounts are due and payable at the time of service.
There is a $40.00 charge for returned checks.
Patients Without Insurance Coverage and Self-pay
Self-pay accounts are those covered by carriers the practice does not participate, patients without insurance, or patients who have not met their deductible.
Unpaid balances over 90 days old, without payment arrangements, may be sent to collections. You will also be responsible for any additional amounts incurred for collecting past-due balances.Payment plans will incur interest.
Letters and Forms
As a courtesy to our patients, we fill out forms. However, we charge for the following:Letter or simple form (other than regular work/school excuse) - $10.00 per letter or simple form
Forms: FMLA, Short-term Disability, etc. - $20.00 Per set
Medical Record Release Fees
Requests for copies of medical records must be made in writing to the clinic. We will fax medical records to a provider of your choice free of charge. However, if you need a copy from us, you will be charged reasonable costs of reproducing the record as provided by applicable law.
Some insurance carriers require referral from your primary care provider. If this authorization is not provided, you will be rescheduled or pay for your visit at the time of service.
If you have any questions or need clarification of any of the policies, please contact our business office.
I have read and I understand the above policy and agree to it in its entirety.