A service charge of $10 will be applied to your account for any co-payment not received at the date of service.
Billing and Collections
You should receive a statement approximately every thirty (30) days unless the charges are pending with your insurance company or your balance is less than $3.00. If payment or denial is not received by your insurance company within ninety (90) days from claim submission, the total amount due will be your responsibility.
Any amount due remaining after your insurance has paid, denied, or not responded, is expected to be paid in full (by you) within thirty (30) days unless other financial arrangements have been made with our Billing Office. Our formal collection process will begin after that time.
We realize that temporary financial problems may affect timely payment of your account. If such problems arise, we encourage you to contact our Billing Office at 704 544-6533. We will do our best to accommodate your individual situation.
Self-Pay and Cosmetic Procedures
If you do not have insurance, or are having a procedure that is not covered by your insurance, payment in full is expected on or before the date of service.
Surgical Services are not covered at 100% by most insurance plans. Once benefits have been applied, patients are frequently responsible for a deductible, coinsurance and/or co-payment. It is therefore required that prior to surgery, financial arrangements be made to cover the balance due after the insurance company pays its portion. The following plan has been made available for your convenience.
CareCredit is a program that offers a line of credit with no interest or low interest payment options. It is “specifically designed for healthcare expenses, and makes it easier for you to get the treatment or procedures you want and need. CareCredit is ideal for co-payments, deductibles, treatment and procedures are not covered by insurance (CareCredit, Inc., 2005).” Please visit CareCredit’s website for details at http://carecredit.com/patients/whatis.htm. Restrictions may apply.
Contact the Billing Office regarding these or other payment options that may be available to you at firstname.lastname@example.org or (704) 544-6533.
Responsible Party for Minors (18 years and under)
We assign all financial responsibility to the parent or guardian that completes and signs the patient registration form. Any amounts due at the time of service are expected from the parent or guardian accompanying the minor to the visit. The minor is responsible if unaccompanied. In the event that a divorce decree assigns financial responsibility for medical bills to another individual, we still hold the registering parent or guardian responsible. We will however assist you in the recover of such payment by providing you with receipts showing that the payment was made.