Terms & Conditions
Co-Payments
Your insurance company requires that we collect your co-payment at the time of service. Patients who are unable to make their co-payments will not be seen and will need to reschedule their appointment.
Deductibles
Patients with deductibles will be required to pay them at the time of service.
Collections
If a patient is sent to collections, a 30% collection fee will be added to the patients account total. The patient will be responsible to pay their bill to the collection agency, not Central Orthopedics.
Child Custody Cases and Second Party Insurance
Central Orthopedics will bill the insurance carrier for the parent who signs the consent. Also, the parent signing the consent for services will be responsible for all outstanding balances unless you have a court order stating otherwise.
Referrals
If your insurance plan requires a referral from your primary care physician it is your responsibility to obtain it prior to your appointment and to have it with you at the time of service. If you do not have your referral, you will be required to reschedule your appointment.
Form Completion
Forms are completed within 5-7 days of receiving them. The form completion fee is $15.00 per form and is to be paid at the time you drop the form off.
FMLA Forms
FMLA forms are the only forms that do not require payment.
Medical Records
Patients requesting copies of their medical records must first sign a release form. The charge for medical records is $1.00 per page and must be requested 5 days in advance.
Refunds
Patients will be refunded any overpayment once all claims on the account have been processed and the patient has been released from care.
Non-Participating Insurance Plans
As a service to our patients, we will file your claim with your insurance company. I understand that if I elect to be treated by any physician or provider at Central Orthopedics who does not participate in my insurance plan I am directly responsible for the balance on my account and may not be reimbursed by my insurance company.
Medicare Supplement Insurance
We are a participating provider with the Medicare Part B program; and as such we are obligated to write off the difference between what Medicare pays us for the services rendered to you (the allowed amount) and our usual and customary charge. Medicare pays 80% of the “allowed amount” to us directly. The remaining 20% co-pay and your annual deductible of $135.00 are the patient’s responsibility by federal law. Although we do file secondary insurance as a courtesy to our patients, any balance after Medicare pays will become patient responsibility and due within 30 days. After 30 days, collection from your supplemental insurer will be your responsibility.
No Show Policy
There will be a $30.00 No Show fee charged to your account if you do not cancel your appointment 24 hours ahead of time. We will not re-schedule an appointment until this fee is paid.
Surgery Pre-Payment
Patients are required to pay their portion of the surgical fee two (2) days prior to surgery. Patients unable to pay will have their surgery rescheduled. If the patient does not notify the office more than 48 hours in advance, regarding their payment, the $200.00 cancellation fee will apply and must be paid before the surgery will be rescheduled.
Surgery Cancellation Fee
If you are having surgery and do not cancel the surgery 48 hours ahead of time. There will be a charge of $200.00 placed on your account. This amount needs to be paid in full before we reschedule your surgery.
Self Pay
All patients without proof of insurance will be required to pay a deposit at check in, $500.00 for fracture care/$300.00 for non-fracture care, in cash, money order, or credit card. These patients will also sign a Payment Plan Agreement at the time of the first office visit.
Payment Plans
Payment Plan Agreements will be set up by the billing department and signed by patients with a high balance on their account. This will be done at the first office visit. Patients will be required to pay on the 1st or 15th of each month.
Worker’s Compensation
If a patient is injured on the job, it must be reported to the employer. The initial appointment is to be handled through the worker’s compensation adjustor. If a patient needs to cancel or reschedule their appointment, the adjustor must do it for them. Our office will not reschedule or cancel appointments without a call from the adjustor.
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Conditions set by Central Orthopedics, P.A.
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