We appreciate and value your confidence in our medical care, and we do what is possible to minimize the cost of our services. You can help by reducing the numbers of bills we send to you. Following is a summary of our payment policy.
Payment at the Time of Service
Payment is required at the time services are rendered unless other arrangements have been made in advance. This includes applicable co-insurance and co-payments. Marina Medical accepts cash, personal checks (in-state only), VISA, Mastercard, DiscoverCard, American Express and Care Credit. Your payment can also be made online at www.marinamd.com. There is a service charge for returned checks and late payments.
Marina Medical makes your visits more affordable by providing a 10% Same Day Payment discount when your account is at zero and your new services are paid-in-full the same day. Patients with an outstanding balance that is 60-days-or-more overdue must make payment arrangements prior to scheduling appointments.
Insurance
Because Dr Brown does not contract with commercial insurance companies, your benefits are based on your out-of-network benefits. Your insurance policy is a contract between you and your carrier(s), not Marina Medical. There are some insurance plans we cannot accept. We do not accept any plan that restricts coverage to an in-network doctor or State Insurance.
If your plan does not have any Out-of-network provider benefits, this means that you are required to go to an in-network doctor or get a referral from your in-network doctor for your plan to cover. You are responsible for getting the referral with your in-network doctor. This may require an office visit with your in network doctor to acquire.
State Insurance goes by many names. Just a few are Apple Health, Provider One, Medicaid, Community Health Plan. There may be others we don't know about, however we do not accept any of these insurance plans
Your bill is your responsibility, regardless of your insurance company's policies and procedures. It is your responsibility to understand your benefit plan and to communicate directly with your insurance carrier when you have questions about your policy or benefits.
As a courtesy to you, we are happy to bill your insurance claims. Of course you are expected to pay your deductible, co-payments and co-insurance at the time of service.
If your bill is not paid in full at the time of your visit, we require that a separate addenda to this financial policy be signed. In addition, we must keep on file your credit card information covered in a separate addenda.
Your remaining patient balance will be billed immediately upon our receipt of the Explanation of Benefits (EOB) from your insurance company. Your remittance of that balance is due within 10 business days of your receipt of your bill. If you have additional questions or concerns, please let us know. We'll do your best to help you find solutions.
Missed Appointments/Late Cancellations
Cancellations are requested 24 hours prior to the appointment. We reserve the right to charge for missed or late-cancelled appointments. Excessive abuse of schedule appointments may result in discharge from the practice. The fee for a missed appointment is $50.00.
I have read and understand Marina Medical's Financial Policy. I agree to assign insurance benefits to Marina Medical whenever necessary. I also agree that if it becomes necessary to initiate action for an unpaid balance, in addition to the amount owed, I also will be responsible for any additional collection or legal fees incurred.
Signature of Insured or Responsible Party
Todays Date
