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Payment Policy *new patient form*

Flagstaff Family Physicians, P.C.

Payment Policy

We participate in most insurance plans. If you are not insured by an insurance plan we do business with, payment in full is expected at each visit. If you are insured by a plan we participate with with but don't have an up-to-date insurance card, payment in full is required until we can verify your insurance coverage. Knowing your insurance benefit is your responsibility. Please contact your plan if you have any questions regarding your coverage.

Co-insurance, Co-payments & Deductibles

All co-payments and co-insurance and deductible amounts must be paid at the time of service. We accept cash, check and major credit cards such as Visa, MasterCard and American Express. If there is a balance on your account or your family member's account, you will be responsible for payment before you are seen.

Non-Covered Services

Please be aware that some-perhaps all- of the services you receive may not be covered (this includes physicals, skin tag removals or other procedures ) . You are responsible for services even if your insurance company deems them not medically necessary. Payment in full is expected.

Proof of Insurance

All patients must complete our patient demographic form. We must obtain a copy of your current insurance card to provide proof of coverage. If you do not have proof you will be responsible for paying your balance in full at the time of service.

Claims Submission

We will submit your primary insurance claim and assist you in any way we reasonably can to help get your claim paid. Your insurance company may need you to supply certain information to them directly (other insurance coverage, for instance). It is your responsibility to comply with their request. Please be aware that the BALANCE of your claim is your RESPONSIBILITY . If your insurance doesn't pay within 30 days, you will be required to pay in full. If you have secondary insurance, you are responsible to setting up a crossover. A crossover is when your primary insurance sends your claim directly to your secondary insurance company.

Coverage Changes

If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. It is your responsibility to provide accurate and correct billing information to our office.

Nonpayment

If your account is over 30 days past due, you will be contacted and payment is needed in full. Partial payments will not be accepted unless otherwise negotiated. Unpaid balances will be sent to Northern Arizona Credit. You will be charged a $50.00 processing fee in addition to the outstanding balance as well as the collection agency's fee of 35-45 % of your total balance. You will need to find a new doctor within 30 days.

Missed Appointment

Our policy is to charge $50.00 for a missed appointment or a last minute cancellation. These charges are your responsibility and will be billed directly to you, not your insurance company. Please help us serve you better by keeping your scheduled appointment(s).

Mission Statement

Our practice is committed to providing the best treatment to our patients. We provide good quality care and want you to feel like family. Our prices are representative of the usual and customary charges for our area. Thank your for understanding our payment policy. Please let us know if you have any questions or concerns.

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