Financial Policy

Texas Modern Gastroenterology (TMG) Financial Policy

Texas Modern Gastroenterology (TMG) is committed to providing high-quality medical care while maintaining transparency in financial policies. We comply with federal and state regulations, including the No Surprises Act, to ensure that patients receive clear information about their financial responsibilities.

INSURANCE & PATIENT RESPONSIBILITY

• Understanding Your Coverage: TMG participates in many insurance plans, but coverage varies. It is the patient’s responsibility to understand their benefits, including deductibles, co-pays, co-insurance, and any out-of-network costs.
• Verification & Claims Submission: We will submit claims to your primary insurance and, as a courtesy, to secondary insurance if information is provided at the time of service.
• Insurance Denials & Patient Responsibility:
  • If a claim is denied by your insurance provider for any reason, including lack of coverage or unmet deductible, the patient is responsible for payment of the denied amount.
  • If your insurance requires additional information from you to process a claim, you must provide the necessary information promptly. Failure to do so may result in the balance being transferred to you as the responsible party.
• No Surprises Act Compliance:
  • If you are uninsured or self-pay, you are entitled to receive a Good Faith Estimate (GFE) for the cost of services before they are performed.
  • If a service is out-of-network and falls under the No Surprises Act, we will provide an estimate before services are rendered.
  • Patients must sign a consent form before receiving non-emergency out-of-network services.

OUT-OF-POCKET EXPENSES & PAYMENT OF SERVICES

• Co-Pays, Co-Insurance, and Deductibles: These amounts must be paid at the time of service as required by your insurance plan.
• Non-Covered Services:
  • If a service is not covered by insurance, the patient is responsible for full payment.
  • Patients may request an estimate before treatment.
  • For services that may not be covered, patients will be asked to sign an Advance Beneficiary Notice (ABN)or financial responsibility agreement before proceeding.
• Outstanding Balances:
  • Patients with outstanding balances must pay before their next appointment or set up a payment plan.
  • If a balance remains unpaid for 90 days, the account may be sent to collections, and the patient may be discharged from the practice.
• Payment Plans & Financial Assistance:
  • Payment plans are available for eligible patients upon request.
  • A valid credit card must be kept on file for any approved payment plan.

CANCELLATION & MISSED APPOINTMENT POLICY

• Cancellations must be made at least 24 hours in advance to avoid a $25 fee.
• After three (3) missed appointments without proper notice in a 12-month period, the patient may be discharged from the practice.

NON-PAYMENT & COLLECTION POLICY

• 30-Day Grace Period: Balances are due within 30 days of the first statement date.
• 90-Day Non-Payment Policy:
  • If a balance is unpaid for 90 days with no payment arrangements, the account may be sent to collections.
  • A final notice will be sent by certified mail before termination from the practice.
  • Emergency care will be provided for 30 days after termination notice.

ACKNOWLEDGMENT & AGREEMENT

By signing below, you acknowledge that you have read and agree to the Texas Modern Gastroenterology Financial Policy. If the patient is unable to sign, the individual signing below is the legal guardian or financially responsible party.