Credit and Payment Policies
PURISIMA FAMILY MEDICINE CREDIT AND PAYMENT POLICIES
- You must present your insurance identification card at the time of the visit. If you do not have proof of insurance with you at the time of your visit, you will be considered a cash pay patient.
- WE WILL REQUIRE THAT YOU PAY THE CO-PAYMENT AND ANNUAL DEDUCTIBLE PRIOR TO YOUR OFFICE VISIT.
- All balances are due within 30 days of receiving service. If you are unable to pay in full within 30 days please contact our office to set up a Payment Arrangement (P.A.) for regular monthly payments. Accounts may be assigned to an outside collection agency and reported to the credit bureaus when personal balance is over 90 days old and/or P. A. payments are missed. Patients whose accounts have a past due balance may be thereafter on a cash basis with no extension of credit for future services and may be subject to dismissal.
- Regardless of insurance coverage, all services provided are the financial responsibility of the patient or the parent(s)/guardian(s) of the patient.
- We offer a cash pay discount of 50% on office visits and physical exams when paid in full at the time of service if we are not contracted with your health insurance carrier.
- You may pay with cash, personal check, money order, credit card, or bank debit card.
- 1.5% monthly finance charge (18% APR) added to accounts that are delinquent.
- $25 - Copay billing. Added to account if copay not paid at time of service. Non-urgent care may be subject to rescheduling when copay is not paid.
- $50 - Returned check. Added to accounts for which check payment is not honored by the bank. Returned checks must be recovered within 10 days or the patient may be denied future services from this clinic. If a check is returned for non- sufficient funds more than once by a patient/guarantor then payment will only be accepted by cash or credit card.
- $75 – No Show. Added to account when the patient does not keep a scheduled appointment and doesn’t cancel/reschedule at least 24 hours prior to appointment time.
$100 - Collection. Added to accounts assigned to an outside collection agency