We would like to welcome you to our office, and are happy you have chosen us for your medical care. Our goal is to provide you with the best possible care available. In order to meet this goal, we need your assistance and understanding of our patient policies. Our Financial Policy is a necessary part of assuring the financial resources needed to maintain this health care facility for our patients.
We are here to help answer any questions you may have regarding your insurance coverage and payments. However, your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contact, uless we are a PPO provider with your plan. Insuance payments are based on a Usual and Customary Rate (UCR) by most companies. Our fees generally fall within the UCR range; unfortunately, some insurance companies reimburse on a fee schedule which may bear no relationship to the current standard and cost of care in this area. Unless we are participants with your plan, you will be responsible for our charges regardless of the company's arbitrary determination of UCR. If we are a part of your PPO, we will file your claims directly to your company. If we are not, we will supply you with an extra copy of your visit to send to them.
Full payment of services is due at the time of your visit. We accept cash, checks, Visa/MasterCard, American Express, and Discover credit cards. If you have a PPO plan, co-payment and deductible amounts will be collected at the time of the visit.
We will file insurance claims for patients requiring surgery. Surgery deposits are required prior to the procedure. The deposit is an estimated amount and consists of your deductible (if not met) and your co-payment percentage (i.e. 80/20% or 70/30%) of the total cost. We will do everything we can to ensure your claim is paid. However, you are the responsible party, and you will be expected to pay any remaining balance.
Balances that are due for greater than (60) days will begin incurring interest at an annual percentage rate (APR)of 15%.
These fees for completion/preparation of the following forms/correspondence may not be covered by your insurance plan. Forms for disability, written correspondence to employers, schools and insurance companies. These fees are collected in advance. I have read the above and I understand and agree to this financial policy.
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Dr. Peter R. DeFrank - Dallas Foot Care Center
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