Office Financial Policies
By signing below, I acknowledge that I have had an opportunity to address any concerns about the information below with Bridge to Life Clinical Consultants (BTLCC) staff, either in person or by telephone conversation. I consent to the services being offered to me by BTLCC and I am satisfied with the explanation. I acknowledge that I have read or have had read to me the financial policies and understand the information presented. I agree to pay any fees incurred if the procedures below are not adhered to.Payment is Expected at the Time of Service
- Payment is required at the time services are rendered. This includes applicable co-pays, co-insurance, deductibles and outstanding account balances. Clients who have an outstanding balance must make arrangements for payment prior to scheduling follow up appointments.
- Payment can be made with cash, personal checks or any major credit card. If a personal check is returned for insufficient funds, we will charge a $35 fee and request an alternate method of payment.
- A surcharge of $10 will be applied for copayments and deductibles not paid on the date of service.
- Please note, missed appointments impact us negatively and signifies a cost to our office and other clients who could have been seen in the time set aside for you. We will apply a $25 surcharge to missed appointments (No call & No show). We understand emergency situations can occur and we will waive this fee for clients who call to cancel or reschedule their appointment within a reasonable time period of 12 hours or more before their scheduled visit time.
- A surcharge of $25 will be applied should you have two consecutive appointment cancellations.
- A surcharge of $10 will be applied for late show up of more than 15 minutes after scheduled visit times. Exceptions are allowed if you notify our office of a reason for delay at least 30 mins in advance.
- For clients using medical insurance, your insurance policy is a contract between you, your employer (if applicable) and your insurance company. You are personally responsible to understand how your policy works, including covered benefits for office visits, immunizations, and lab work. We will bill your insurance on your behalf, if we do not receive payment from your insurance company within 60 days from the date of service, you will be expected to pay the billed balance.
- It is your responsibility to update your demographics and new insurance information with our office. All invoices are sent by email and/or mail to the address on file. If your insurance denies coverage or reimburses less than the allowable amount and you did not receive the invoice due to wrong address, we will assume that you have been notified of the amount due from the explanation of benefit (EOB) sent to you by your insurance.