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Page 2 of 7 - Scroll to the bottom for submit button. Providing quality medical care for our patients is our primary concern. The following is a summary of our financial policy. We would be happy to provide further clarification if necessary. We ask that you read and sign the following to acknowledge that you have been advised of your financial responsibility for medical services provided here. We accept certain insurance plans; therefore please provide us with your insurance card. We will let you know if your plan is one for which we are a designated provider. If you wish to be seen at Aveon Health, you are responsible for payment of all co-pays and/or deductible charges at the time of service. If your insurance is a plan for which we are not a designated provider, we are more than willing to provide care and you will be responsible for payment at the time of service. Your insurance coverage is an agreement between you and your insurer. It is your responsibility to remit payment for charges not covered by your claim and ensure your carrier remits payment. If a problem occurs with your claim, you will be required to establish written financial arrangements with Aveon Health until your insurance problem is resolved. Please remember that insurance policies may not cover all conditions and fees. To be fully aware of your schedule of benefits, please read your policy or talk with an insurance representative. Any laboratory analysis that we require, but do not perform in-house will be sent to an external laboratory as required by your insurance. You may receive a separate bill for laboratory services. We accept payment in the form of cash,credit or debit card (VISA, MasterCard & Digital Currency). Any checks returned to us due to insufficient funds will result in a fee of $25.00 each. All patient accounts are due and payable within thirty (30) days of services rendered. Each month you will receive a monthly statement for services, which is due and payable within thirty (30) days. If your payment is late, or if you have not previously made financial arrangements, then we will mail a reminder notice indicating there is a problem with your account. If three consecutive reminders are mailed to you and you do not respond then your account will be sent to collections and you will not be allowed to schedule an appointment until your entire account balance is paid in full. Please notify us immediately if a mistake appears on the statement. Aveon Health offers appointment reminder calls as courtesy to our patients. If you arrive more than 15 minutes late for your scheduled appointment, we may ask you to reschedule your appointment. If you No Show an appointment or cancel and do not notify us at least 24 hours prior to your scheduled appointment, you may be charged a $30 No Show Fee. Any early weekend or extended appointments missed may be charged $60.00. After 3 No Shows the office has may discharge you from our care, as your absence impedes your provider from providing quality medical care. |