We like to inform as much as possible regarding any out of pocket expenses you may have at your visit. Please see our appointment terms and conditions.

We request that all patients sign their consent forms either 48 hours prior to appointment (or by 8 pm if booked less than 48 hours or 1 hour prior to appointment if booked same day) prior to appointment confirmation. 

Appointments that are not checked in by noon 8 am 2 days prior to appointment (or by 8 pm if booked less than 48 hours or 1 hour prior to appointment if booked same day) are subject to cancellation, wait listing or rescheduling and fees or forfeiture of deposit will occur. If you do not check-in a $45 fee will be assessed.  Same day or cancellations < 48 hours or no shows for insured patients are subject to fees of $45.   No shows, same day or cancellations < 48 hours for self patients will forfeit (lose) their visit deposit. If a cancellation is required for an appointment that is scheduled for the next day (for example an appointment is scheduled on Thursday for Friday) we must receive the cancelled within 1 hour of booking in order to not incur fee.  

We do require that all patients leave a credit card/FSA/HSA card on file for any balances not paid by insurance or balances on account.  If you would prefer to not leave a card of file you may leave a $300 deposit on file to cover any balance not paid by insurance or balances on account.  All cards left on file are secured with bank level encryption and are PCI-1 compliant. 

Payment (including copays, coinsurance or deductible) in full is due at time of service. 

  • If you have a deductible and either present for non preventative services or have a non preventative issue discussed during the service then your deductible will be applicable and due at the time of service.  
  • If we cannot verify your benefits electronically at the time of service then a prompt pay deposit for charges will be due until your insurance fully adjudicates your claim.  
  • If your insurance does not offer real time claims adjudication or cannot provide a real time adjudication response at the time of service then a prompt pay deposit for charges will be due until your insurance fully adjudicates your claim.
  • We no longer bill telemedicine services directly to insurance.  If your insurance does cover telemedicine you may be able to submit your invoice and receipt directly to your insurance for reimbursement when applicable.  Rates are determined based on time of visit and visit length is determined based on the complexity of your individual case, history and reason for visit. For visit rates please click here.
  • If you are self pay payment is due at the time of appointment booking

We only accept credit or debit cards (Visa, Mastercard, American Express). We also offer financing through Paypal (15% office finance fee applies) or Parasail patient financing (no office finance fee) for patients who may not be able to pay at the time of service.  We can only enter into a financing agreement at the time of service and not post insurance adjudication without an additional $50 finance processing charge.  We require all patients to leave credit card authorization on file for any charges that are deemed to not be covered by your insurance, charges that fall under the deductible portion of your plan or administrative fees that are assessed by the practice such as cancellation, no check in, forms and no show fees. If you are an established patient that has a balance on file these balances and fees can be charged to your card on file at the time of appointment booking. 

For Self Pay patients only:  Patients are required to pay deposit for appointment at the time of booking. The card that is left on file will be charged for your assigned charges. No shows and/or cancellations will forfeit the entire deposit amount. If you need to cancel your appointment within the check in deadline period and you cannot reschedule your deposit amount will be forfeited. If your appointment is rescheduled your deposit will be forwarded to your rescheduled appointment.

For insured patients: Please select the option to leave card on file or provide card for payment as instructed when booking your appointment.  Please note that for most patients co-pays are not required for the annual gynecologic exam however please check with your plan for your specific benefits.  Please note that if you have an HMO plan that you may be required to obtain an authorization from your primary care provider PRIOR to your visit with us.  If you have an HMO plan please contact your PCP for this authorization and have it faxed to 281-487-3831.

 

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