The Carrell Clinic

Financial Policy

The Carrell Clinic™ is committed to providing you with the best possible care and can discuss our professional fees with you at any time. It is important to our patient physician relationship that you read and fully understand our financial policy. Please let us know if you have any questions about your financial responsibility.

New patients are required to complete patient registration documents and medical history form via an electronic registration tablet prior to seeing the physician. Established patients are required to update their information forms at least once a year via the same electronic registration tablet. We will ask to see your insurance card and driver’s license on every visit and will scan your card into our system as needed to keep our information current. Patients are required to pay Copayments/Deductibles upon arrival to their visit. You can make your payment to the Front Office Receptionists with cash or check or by Credit Card on the tablet you are provided at check-in.


Please present your insurance card at each appointment along with photo identification. Your insurance requires that we collect your designated co-pay and/or deductible at the time of service. Please be prepared to pay the above fees at each visit.

Insurance Policy:

Your insurance policy is a contract between you and your insurance company. If you did not follow your insurance plan’s terms, 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 the balance in full.

We will bill participating insurance companies as a courtesy to you. We do require that payment of deductible, co-pays and co-insurance be paid at the time of service.

Out-of-network Insurance Plans:

We do not bill third party insurance companies such as: Auto or Liability Insurance; therefore, payment is expected in full at the time of service. However, we will provide you with the necessary documentation to help you submit your claim to the appropriate insurance carrier.

Self-Pay Patients

Payment is due at the time service is rendered unless other arrangements have been made in advance. For your convenience, we accept cash, check (in state only), VISA, Master Card, Discover, and American Express. You may also pay your bill online at


If your Insurance Plan (Primary or Secondary) requires a referral from your Primary Care Physician it is YOUR responsibility to obtain it prior to your appointment and to have it with you at the time of the appointment. If you do not have your referral, you may be required to reschedule.

Orthopedic Supplies:

Some orthopedic supplies are not covered by your insurance requiring payment at time of service. A $300 deposit will be collected upon the receipt of certain DME items.


We will submit to Medicare for the Medicare allowed amount. The patient will be responsible for the deductible and the co-insurance, which can be billed to a secondary insurance if applicable.

Returned Check Fees and Appointment Cancellations:

Any returned check from the bank for non-payment (insufficient funds) shall result in the patient’s account being assessed a $35 fee per check returned.

Appointment Cancellations within 24 hours of the scheduled time may result in a $45 charge.

Delinquent accounts:

Patients with an outstanding balance 60 days or more must make payment arrangements prior to scheduling appointments.

Parental Consent:

Responsibilities for payments who are minor children, whose parents are divorced, rest with the parent who seeks the treatment (The parent is the guarantor). Any court ordered responsibility judgement must be determined between the individuals involved, without the inclusion of The Carrell Clinic™.

Forms Completion/Medical Records Requests:

Please visit the Carrell Clinic™ website at Look under Patient Information and you will find a section called "Request Medical Records."

We accept cash, MasterCard, Visa, Discover, American Express, debit cards, and checks. Online payments can be made at