We are dedicated to providing the best possible care to you and regard your understanding of our financial policies an essential element of your care and treatment. The Carrell Clinic financial policy is intended to clarify these issues.
- Please present your insurance card and photo ID at each appointment.
- Your insurance policy is a contract between you and your insurance company. If you did not follow your insurance plan’s terms, including obtaining the necessary referral authorizations, they may not pay for all or part of your care, and you may not qualify for any managed care discounts. If your insurance company does not pay within 60 days of the date of service, you may be expected to pay for the balance in full. You are responsible for understanding the terms of your health insurance policy.
- Self-pay patients: Payment is due at the time the service is rendered unless other arrangements have been made in advance. We accept cash, checks, VISA, MasterCard, Discover and AMEX.
- You may pay your bill on-line at www.carrellclinic.com. Payment plans are offered through our on-line payment portal or Care Credit.
- Responsibilities for payments for patients who are minor children, whose parents are divorced, rest with the parent who seeks the treatment (This parent is the guarantor.) Any court ordered responsibility judgment must be determined between the individuals involved, without the inclusion of The Carrell Clinic.
- You must provide your most current billing address, all available telephone numbers, email address and any important contact information. If this information changes it is your responsibility to contact us with your updated information.
- We charge for certain forms such as Disability and FMLA forms, as well as medical records. Information can be found on our web site, www.carrellclinic.com under Patient Information.
- We bill participating insurance companies and obtain authorizations as a courtesy to you. If your insurance company requires your social security number to file a claim, you will be required to provide it or pay for services at time of service. We require that payment of deductibles, co-pays, surgery deposits, non-covered items and co-insurance be paid at the time of service. You are financially responsible for services not covered by your insurance company including those services that were initially approved by your insurance carrier but were subsequently denied by your insurance carrier.
- It is the policy of the Carrell Clinic to require the patient keep a credit card on file for all surgical procedures. Any balance due after the insurance company pays will be automatically charged to your credit card. Any balances due to over payment by the patient when making a surgery deposit will be refunded to the credit card on file.
- If after all your claims have been paid, and the resulting balance is a credit of $5.00 or less, you will allow us to write off this balance. Amounts greater than $5.00 will be refunded to you.
- We do not bill third party insurance companies such as Auto or Liability Insurance; payment is expected in full at time of service. We will provide you with the necessary paperwork and forms to you to submit your claim to your insurance carrier.
- Some orthopedic supplies are not covered by your insurance requiring payment at time of service.
- For ERISA, Out-Of-Network and Self-Funded plans, I hereby assign and convey directly to the Carrell Clinic, as my designated authorized representative, all insurance reimbursement for services rendered by the Carrell Clinic regardless of its network participation status. I authorize the Carrell Clinic and its billing company to negotiate, discuss, appeal and in any other way communicate with my insurance company in determining the final payment for services I received. The Carrell Clinic and its billing company has full authorization to accept or reject any proposed reimbursement proposal, act in whatever way necessary to accomplish the final adjudication of any and all claims, and the results of that determination is binding.
- If you have a balance after we receive payment from the insurance company, we will mail you a statement to the billing address you provide. Payment in full is due upon receipt. Patients with an outstanding balance 60 days or more overdue must make a payment arrangements prior to scheduling appointments. If you do not pay your balance and we are required to use a third party to collect your balance a charge of 25% of the balance will be added to the amount you owe.
- Appointment cancellations within 24 hours of the scheduled time may results in a $45.00 charge. Returned checks for any reason will results in a $35.00 charge. Failure to notify us 48 hours before cancelling a surgery may result in a $100.00 charge.
- The Carrell Clinic Billing Coordinators are available to help you with your billing questions Monday through Thursday between 8:30am and 5:00pm by calling (214) 220-2468.
I/we assign to Medical Staff Physician, and Health care providers, and authorized direct payment to Facility(s) all insurance benefits or Medicare benefits which may be entitled. This assignment includes, but is not limited to, major medical and disability insurance proceeds and benefits accruing under any settlement, structured or otherwise, or awarded in judgment for personal injured caused by a third party. I/we agree to pay Facility(s) for any and all charges not paid pursuant to this assignment.
I have read and understand The Carrell Clinic Financial Policy agree to abide by its guidelines.