We are dedicated to providing the best possible care and service to you and believe that your understanding of your financial responsibilities is an important element of your relationship with our practice. In order to reduce confusion and misunderstanding between our patients and the practice, we have adopted the following financial policy:

YOUR INSURANCE POLICY IS A CONTRACT BETWEEN YOU AND YOUR CARRIER. THE DOCTOR IS NOT INVOLVED. All health plans are not the same and do not cover the same services at the same payment schedule.  Due to the large number of plans we deal with, we can’t assure you that any specific amount of any charge will be covered.  Your involvement in knowing what your insurance covers is important and we encourage you to become familiar with your plan.  This information is best obtained by calling your insurance company.

IF YOUR INSURANCE REQUIRES A REFERRAL, IT IS YOUR RESPONSIBILITY TO OBTAIN THAT REFERRAL. Please check with your carrier to see if your visit to a specialist requires a referral. If your policy stipulates that you need a referral and you do not have one, we will give you the option of rescheduling your visit or signing a waiver. Again, this is your contract with the insurer and we have little ability to impact it.

WE FILE INSURANCE CLAIMS FOR ALL PATIENTS WITH WHOM WE HAVE A PARTICIPATING AGREEMENT. We would like to participate with and accept assignment on all insurances, but we can’t due to limitations by the insurance companies on panels. We have asked to be included in a number of networks, but if we don’t participate it is usually because of circumstances beyond our control. This is always a concern for us and we work to increase our options and serve all that would like to have our care. Please be sure that your insurance will permit you to see us. This is especially true for POS and HMO networks.

Deductible co-payment and “non-covered” amounts are the responsibility of the patient. They are due at the time of service. PLEASE DO NOT ASK US TO WAIVE CO-PAYMENT OR DEDUCTIBLES, AS THIS IS A VIOLATION OF YOUR INSURANCE CONTRACT and an embarrassment to all concerned.

Payment is due in full when you receive a statement from our office, unless we have made arrangements in advance.

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Financial Hardship

Financial hardship involves a situation where a person is unable, reasonably, to meet their financial obligations to us. Financial hardship can take place over a limited timeframe or be long-term. Financial hardship can arise from causes such as illness, unemployment or some other unexpected change to income or expenditure expectations. Patients who claim they cannot financially pay any amounts owed will be

In the interest of making a financial hardship determination, a Financial Hardship Waiver Application is needed. The purpose of this application is to enable PKA to evaluate the level of assistance eligibility. The following documents must be submitted with the application:

  • W-2 Withholding Statements from Previous Year
  • Pay stub for most recent pay period showing year-to-date.
  • Any and all documents to support additional income as outlined on the hardship application.