We are pleased to have you as our patient. Tri-City Foot & Ankle Center is dedicated to providing quality, accessible, and cost effective health care services to our patients and we strive to make every visit a positive experience. This information was designed to provide our patients with a detailed explanation of our financial policies. We realize this information may not always address your specific situation and encourage you to speak with a member of our staff whenever you have any questions or concerns regarding your account.
CREDIT/DEBIT CARD ON FILE: We strongly encourage a credit card on file if we will be billing insurance for you. The information will be held securely. When your portion of the bill is determined (following a review of your copay, co-insurance, and deductible) we will charge your card and a copy of the receipt will be emailed to you. You can remove your credit card on file by giving written notice.
We accept Visa, Mastercard, and Discover.
PAYMENT FOR SERVICES: Payment for services is due at the time that those services are provided to you, and we expect that all charges we present to you at a visit will be paid at the time of the visit. This includes copay amounts, program deductibles, earlier charges that remain unpaid, and charges for services that we believe are not covered by, or are left over as your responsibility to pay after coverage by, insurance or government programs. Payments may be made by cash, check or credit card. There will be a $25.00 charge for returned checks. Delinquent accounts will be referred for collection at the discretion of the office manager.
UNPAID BALANCES AND AUTOMATIC PAYMENTS: Patient balances are due upon final insurance determination of patient balance and will be charged to your credit card on file. Statements will be available via email at your request.
CO-PAYS AND UNPAID BALANCES DUE AT TIME OF VISIT: Please be prepared to pay all co-payments and unpaid balances at the time of service. We do not send bills out for co-payments, so your visit will have to be re-scheduled if you are not prepared to pay the co-payment.
INSURANCE: If your doctor is a participating provider with your insurance plan, we will submit the claim to your insurance company. To do this we must have complete and accurate insurance information and a copy of your identification card or claim form. Your insurance policy is a contract between you and your insurance company; therefore you are responsible for payment whether or not your insurance company pays. It is your responsibility to contact your insurance company regarding pre- authorizations, obtaining required referrals, second opinions, etc. Failure to do so may reduce the amount of benefits paid by your insurance, and the balance will then become your responsibility to pay.
To see more insurance information: Click here
NO INSURANCE: If you do not have insurance or the doctor is not a participating provider with your insurance plan, please be prepared to fully cover the fees for each visit at the time of treatment.
BILLING COMMUNICATIONS: We may present charges to you by written statement via the mail following a visit. If we do this, we expect that each charge will be paid in full by return mail or online via our patient portal the first time it is presented to you.
CO-PAYMENTS: Co-payments will be collected at the time of your visit. Please check with your insurance company for the requirements and provisions of your policy to determine the dollar amount of your co-payment prior to your appointment.
DEDUCTIBLES: If you have an annual deductible which has not yet been paid in full, then any charges incurred up to that amount are due at the time of your visit.
MINOR PATIENTS: The adult or the parent (custodial guardian) accompanying a minor is responsible for payment of services. For unaccompanied minors, non-emergency treatment will be denied unless prior authorization from the parent or guardian has been made for the charges and treatment.
SUPPLIES: For your convenience we make some supplies available for purchase in the office. If you choose to purchase these items, payment is due at time of purchase. We also offer a link to our online store with a greater array of products, which can be accessed through our Online Store.
ASSIGNMENT OF BENEFITS: When seen at Tri-City Foot & Ankle Center, you authorize your insurance benefits to be paid directly to Tri-City Foot & Ankle Center and/or its doctors. The office will bill your insurance as a courtesy and the patient is responsible at the time of service for all co-payments, deductible, unpaid balances and non-covered services. The patient must also authorize the release of information required to process the insurance claims.