Pediatric Specialists of Tulsa (PSOT) requires a credit card to be on file. Our credit Card transaction company is Instamed. Instamed stores the information on a separate, secure site. This enables us to run credit card transactions within our system. Office personnel will not have access to your card. Only the last 4 digits of your card will show in our system. Instamed is certified as a Level One Service Provider with the Payment Card Industry (PCI), Data Security Standard, as well as the VISA Cardholder Information Security Program (CISP). They are audited and scanned for PCI compliance and is regularly scanned for vulnerabilities by ScanAlerT and is a member of their HACKER SAFE program.
For all patient responsibility amounts assigned by insurance, our office reviews these amounts to ensure your claim has been properly adjudicated. If what is adjudicated by the insurance company does not match your benefits we verified with insurance at the time of service, we will contact you and your insurance carrier. Members typically receive their explanation of benefits prior to the provider, so if you disagree with the patient responsibility amount owed, it is your responsibility to contact your insurance carrier immediately.
We do our best to verify your benefits prior to the appointment to make sure we collect the appropriate amount owed and to make sure your visit will be covered by your insurance plan. However it remains the policy holder’s responsibility to know their insurance policies. PSOT cannot know all the details of every plan. Ultimately, you are responsible for knowing what services are covered, how often, and how much of the cost is your responsibility. You will be responsible for any portion of services that your insurance does not cover.
I agree to place my credit card on file to be run by Pediatric Specialists of Tulsa. I authorize their staff to run my credit card for purposes stated above.
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