Financial Policy

Financial Waiver

We understand that navigating insurance can be challenging, and we are here to help make the process smoother for you. Your insurance is a vital agreement between you and your insurance provider, and we want to ensure that all claims are submitted promptly on your behalf. To assist us in doing so, please share your most current insurance information and your updated insurance card as soon as you have it available. If any information is incomplete or inaccurate, it may lead to complications with your claim, which could result in you being responsible for the costs. We appreciate your understanding, and please know that if you have any questions regarding your coverage or need assistance, we’re here to support you every step of the way.

  1. It is crucial for the patient to keep all information accurate and up to date, as this ensures smooth processing of your medical claims.

  2. It is the patient’s responsibility to verify the change of PCP before your appointment ( for all HMO insurance). Failure to do so may result in your appointment being rescheduled or additional charges.

  3. We do not do 3rd party billing or workers' compensation insurance

  4. We are not accepting any new Medi-Cal patients

  5. As a courtesy, we bill your insurance. You are responsible for the deductibles and copays. 

    1. DEDUCTIBLE: a deductible is the amount of expenses that must be paid out of pocket by the patient before the insurance will pay expenses

    2. CO-PAY: a co-pay is a fixed dollar amount the patient pays for each office visit and is determined by the insurance plan 

  1. All deductibles and copays are due at the time of service. We will not waive co-pays.

  2. If you find yourself between insurances, we will temporarily collect cash for office visits at the time services are rendered. This process ensures that you are always prepared for your healthcare needs.

  3. Co-insurance and Balances: The patient is responsible for paying any remaining balances on the patient account. 

  4. All outstanding balances are subject to a $10.00 late fee. 

    1. The cost of collecting past due balances is the same regardless of the amount you owe.

  5. It is your responsibility to ensure the address on file for statements is correct

  6. All balances over 90 days past due and over $ 50.00 without an arrangement on file will be sent to a collection agency. Payment arrangements can be made with our billing department. Our billing department must agree to this arrangement

  7. Payment plans are not to exceed 3 months

I authorize medical benefits to be paid directly to the physician for services rendered. This allows for a smoother and more efficient claims process. I also allow my physician to release any medical information necessary to process claims with my insurance companies.

I have read and accepted the above. I understand and agree that I am responsible for any unpaid charges and balances not covered by my insurance. This awareness ensures that you are fully accountable for your healthcare expenses. 

If the patient is a minor ( under 18 years old), then the responsible party (parent or guardian) must sign above and complete the following information: