Financial Responsibility
Responsibility for payment. Remember, you are responsible for payment in full for any services you obtain from our office. You are responsible for making payment at the time services are made unless other arrangements are made.
Insurance
We are out of network with all private insurance carriers. We are happy to submit insurance claims directly to all private carriers for you so that you can obtain out of network reimbursement.
Medicare
We have opted out of Medicare. Patients who have Medicare sign a Private Contract acknowledging that we do not bill Medicare for any services. They will pay our office directly for all services and not seek reimbursement from Medicare.
Medicaid
We have opted out of Medicaid. Patients who have Medicaid sign a Private Contract acknowledging that we do not bill Medicaid for any services. They will pay our office directly for all services and not seek reimbursement from Medicaid.
Insurance Information
You are responsible for letting us know about your insurance coverage and for providing necessary information so we can bill your insurance.
Change in Insurance
If there is a change in your insurance coverage, you must let us know before coming in to make sure that the visits are billed correctly. If your insurance coverage changes and you don't notify us in advance, then you will be responsible for the full amount of your bill.
Pre-Authorization
If your insurance requires pre-authorization or prior approval before services are provided, you are responsible for letting us know this and insuring that appropriate pre-approvals are obtained.
Expiration Dates
We are asking everyone who has coverage or pharmacy benefits requiring re-authorization to pay attention to expiration dates and remind us of these dates. This will help us make sure that the necessary approvals have been obtained ahead of time.
Missed or Cancelled Apppointments
If you are unable to keep an appointment, please cancel by 12 noon the prior business day so that we can offer your time to another patient. If you are unable to come because of an unforeseen situation such as physical illness, please call as soon as you know you will not be able to come. Other patients are waiting for these appointments. If you repeatedly no-show for your appointments, we will find it necessary to charge you for missed appointments.
Returned Checks
There is charge of $25.00 for returned checks.
Medication Renewals
If you need prescriptions sent to your pharmacy between appointments, please text or call before 12:30 pm with the following information:
Pharmacy name and number
Medication name & dosage
How often you are currently taking the medication
Date of your next appointment
The renewal will be sent electronically by 7:00 pm the same day.
Any medication request made after 12:30 pm will submitted to the pharmacy by the next working day.
Copyright © 2018-2022 Peter B van Dyck MD & Associates PA - All Rights Reserved.
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