1. Co-pays are due at time of service. Our contractual agreement with your carrier prevents us from waiving your required co-pay amounts.
2. LCFM practice will file insurance claims for patients as a courtesy. Your insurance policy is a contract between you and your insurance company. The bill is your responsibility whether your insurance company pays or not. We cannot bill your insurance company unless you give us the correct insurance information. It is your responsibility to inform the practice if and when that information changes. If your insurance company has not paid your account in full within 45 days, the balance will automatically become your responsibility. Please be aware that some perhaps all the services provided maybe non-covered services. And may not be considered reasonable and necessary under the Medicare Program and/or other medical insurance.
3. If you have no insurance coverage, a payment of $50.00 is due at time of services. You will be billed for the remaining balance, and you must set up a payment plan for the balance. A self-pay discount is applied on any remaining balance.
4. Outstanding balances are due within 15 days of the statement date unless you have made other arrangements with the business office. We will collect all outstanding patient balances prior to each visit. You can call the business office at (402) 779-7207 to make other arrangements for a payment plan. If monthly payments are not received, the account will be sent to an outside collection agency.
5. If you are in collections, you will not be able to make an appointment or get medication refills.
6. If you need to cancel your appointment, call 4 hours prior to your appointment time or a no-show fee will automatically be added to the bill of $50.00, subject to change.
7. We accept CASH, CHECKS, VISA, MASTERCARD AND DISCOVER. In the event of a returned check, there will be a $30.00 returned check fee and you will not be allowed to write any more checks.
8. Call to correct any billing errors promptly. If you ignore our billing statements or telephone calls, we can only assume that you do not intend to pay for the medical services that were provided in good faith and your account will be forwarded to an outside collection agency.
9. Referrals – some insurance plans require that a referral from the primary care physician be obtained prior to being seen. It is the responsibility of the patient to obtain this referral. Failure to obtain it may result in a lower payment or no payment/benefits from your insurance company and you will be responsible for payment.