KNOW YOUR BENEFITS:
Please remember that insurance is considered a method of reimbursing the patient for fees and is NOT A SUBSTITUTE FOR PAYMENT.

UPON CHECK-IN
we will collect your deductible, co-pay, and payment for any uncovered services, as well as, the patient’s outstanding balance. We accept cash, check or credit card of Master Card and Visa. Please insure you present your I.D & medical card (primary and secondary at every appointment.

A copy of your insurance is required. If a copy of the current card is not on file at the time of service and the claim is denied, you will be responsible for the payment.

Your insurance policy is a contract between you, your employer and your insurance company.

We will bill your insurance company once, as a courtesy. If you insurance does not respond within 30 days of claim submission, a statement will be sent to you.
You should call your insurance to question why the claim is not paid. Our office will be happy to assist you, only after you have contacted your insurance company.

All charges not paid by your insurance company are your responsibility regardless of the reason for non-payment. You are ultimately responsible for payment of your account.

If the insurance company denies the claim for a plan provision, you will be responsible for the balance.

Balances older than 30 days after insurance has paid or denied the claim may be subject to interest charges of 1 1/2% per month (18% per year)

If your account is over sixty (60) days old and has had no activity in the recent thirty (30) day period, it may be turned over to a collection agency.

Accounts that have statement returned with no forwarding address will be turned over to a collection agency.

All services are provided to you with the understanding that you are responsible for the cost regardless of your insurance coverage.

Administrative Fees

  • Appointment cancelled with less than 24 hour notice = $30.00
  • Patient “NO SHOWS” for appointment = $40.00
  • Returned payment for Non-Sufficient Funds will be based on Ohio Revised Code, section 2307.61 Civil action for willful damage or theft
  • Patient account placed with collection agency = $50.00
  • Request for release of medical records (paper or electronic) will be based on Ohio Revised Code, section 3701.741 Fees for providing copies of medical record.