Please read this financial policy carefully. If you have any questions about this policy, any member of our staff will be glad to assist you.
The following are the conditions for services provided by Palmetto Internal Medicine & Primary Care for the patients whose name appears above.
PROOF OF INSURANCE: Please bring your insurance card to every appointment. We participate with a large variety of insurance plans. If you are not insured by a plan that we participate with, a payment in full is expected at each time of service. It is your responsibility to ensure that we have your correct information and up to date copy of your insurance card.
SELF-PAY PATIENTS: We understand not all patients can afford insurance, that is why we offer self-pay prices at a discount rate. For all self-pay patient’s, it is required that you pay up front before every visit and before any service is done.
CO-PAYMENTS, DEDUCTIBLES & CO-INSURANCE: All co-payments, deductibles, co-insurance, & outstanding balances must be paid at the time of service. If you have a deductible, we collect a portion of the deductible up front. You will be required to pay the whole balance on your next visit. If you do not have your copay/co-ins/deductible on the date of service, YOU MAY BE REQUIRED TO RESCHEDULE.
CLAIMS SUBMISSION: We will submit your claims and assist you in any way we can to help get your claims paid. Your insurance plan may request information directly from you, it is your responsibility to reply in a timely manner. Remember, your insurance benefits is a contract between you and your insurance plan.
COMPLETION OF MEDICAL FORMS: There may be a charge for completion of forms such as disability, FMLA, etc.
COPIES OF MEDICAL RECORDS: There is a charge for completion of this process; SC Sec. 44-7-325 for Health Care Facilities
- Clerical fee not to exceed $25.00
- $0.65 per page for the first 30 pages, if there are more than 30 pages, the price is reduced to $0.50 per page.
- $15.00 for an itemized bill
A special handling fee of $10 will be charged if records must be delivered within 48 hours of requested date.
NO SHOW APPOINTMENTS: We understand that there may be times you cannot make your scheduled appointments. If need be, you can cancel your appointments via MyChart, our automated reminder system, and by calling our office. We ask that you at least give a 24-hour cancellation notice before your scheduled appointment. If a 24-hour notice is not given, your appointment will be counted as a No-Show. As a courtesy we are no longer charging No-Show fees, but after 4 No-Show or missed appointments you will be dismissed from Palmetto Internal Medicine and Primary Care.
For more information on our No-Show Policy please read our Cancellation and No-Show Policy.
COLLECTION POLICY: If no resolution can be made within sixty (60) calendar days, delinquent actions will be forwarded to a collection agency/or to small claims court and possible discharge from the practice. If you are unable to pay your balance promptly, please call us at 864-277-8300 to make payment arrangements. We will attempt to contact you by phone before your account is forwarded.
QUESTIONS: We are here to help if you should have any questions regarding your statement. **Knowing your insurance benefits is your responsibility. Please contact your insurance plan with questions you may have regarding your coverage**