i-Spine Financial Policy

We are committed to providing you with the best possible care. We encourage you to discuss with us any concerns you have about our professional fees and financial policies.

While we will make every attempt to assist you by filing insurance claims, payment for services is your responsibility.

HMO/PPO

If your insurance is a HMO/PPO plan, co-pays must be made at the time services are rendered. Referral forms are the patient’s responsibility
and must be obtained prior to your appointment from your primary care physician.
Medicare

We accept Medicare assignment and will file your supplemental insurance.
Medicaid

We are not Medicaid providers. Please contact the office immediately if you have a scheduled appointment and have Medicaid.
Worker’s Compensation

We will submit claims to your employer or their insurance carrier for work-related injuries. In order to do this, we must have authorization
from the employer, an accurate billing address, and a contact person’s name and phone number.

Other Insurance/Out of Network

We will file claims as a courtesy to you. However, insurance coverage is a contract between you and your insurance company.
Liability/MVA

If you sustained injuries from a motor vehicle accident or other accident, you must provide us with complete insurance information including
company name, phone number, billing address and contact person’s name so we can file the claim for you.
Attorney

We do not bill attorneys. We expect payment at the time of service and consider the patient, not his attorney, to be financially responsible for
the medical services received. In certain circumstances, we will accept a letter of protection.
Treatment of Minors

Although we will file claims with the appropriate insurance company, the adult accompanying a minor will be responsible for the medical
services received.

No Insurance
We expect payment at the time of service. If this presents a financial hardship, please discuss this with our financial adviser so a payment
arrangement can be made.

Returned Checks
A $25 fee will be imposed on all returned checks.

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