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Financial Policy

In order to reduce confusion and misunderstanding between our patients and our practice, we have adopted the following financial policy. We are dedicated to providing the best possible care and service to you. We regard your complete understanding of your financial responsibilities as an essential element of your care and treatment.

FULL PAYMENT IS DUE AT THE TIME OF SERVICE, unless other arrangements have been made in advance by either yourself or your health coverage carrier (medical insurance). For your convenience, we will accept VISA and MASTERCARD.

YOUR MEDICAL INSURANCE

If you do not bring us sufficient information to bill your insurance (i.e., Name, address, phone numbers of the insurance company, medical group name if relevant, ID and group numbers, date of birth and name of primary insured), then full payment is due at the time of service.

IT IS THE POLICY OF OUR OFFICE TO COLLECT ANY COPAYMENT WHEN YOU ARRIVE FOR YOUR APPOINTMENT. We hold contracts with many insurers and health plans. We will bill those plans with which we have a contract, and will only require you to pay the authorized co-payment at the time of service. If your health plan determines a service to be “not covered”, you will be responsible for payment for the complete charge. Payment is due upon receipt of a statement from our office. If we determine prior to your visit that a service is “not covered”, full payment is due at the time of service.

If you have insurance coverage with a plan with which we do NOT have a contract, we will be happy to prepare and send a claim for you on an unassigned basis. This means that your insurance will most likely send payment directly to you. Due to this, payment is due upon receipt of a statement from our office.

Please Fill out the Financial Policy Form and bring it into our office or Fax it to: (925) 935-1070

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