Financial Policy – READ THIS IT’S IMPORTANT!!
Thank you for choosing the team at JourneyLite Physicians. We are committed to providing the best medical care possible. Please understand that payment of your bill is considered a part of your treatment. The following statement explains our Financial Policy, which we ask you to read, sign and return to us prior to your treatment.
– All patients should provide accurate and complete personal information prior to being seen by our team.
– All applicable co-pays, deductibles, co-insurance, out of pocket maximums, personal balances, both current and prior, are due at the time of service.
– We accept American Express, Discover, MasterCard, Visa, CareCredit, cash, personal checks, cashier’s checks and money orders. ** Personal checks are not accepted for procedure/surgery payment.
-All self-pay patients understand they are waiving the use of insurance. Courtesy billing and patient submission billing is not permitted.
-Patients who have not been seen by a provider within the past 3 years will be considered a new patient and will be required to pay a new program fee.
Program Fees/Consultation Fees
Program fees are charged by almost every surgical weight loss center. It is non-refundable and not covered by insurance. If applicable, the fee is due prior to the initial visit. All fees associated with new appointments are non-refundable. Unused fees may be transferred to other programs within the Practice within 12 months of initial appointment.
Regarding Insurance
In all cases, we require that the guarantor, the person who is financially responsible, is personally liable for all balances not covered by insurance. It is your responsibility to understand and comply with any predetermination of benefits or referral requirements. Please be aware that some, perhaps even all, of the services provided may be non-covered services or may not be considered medically necessary by some insurance companies. This does not mean you do not have to pay for the service. All charges must be paid in full prior to your procedure/surgery. Gastric band evaluations are considered elective procedures. If your account is past due, we do not have to provide continued band evaluations.
Patient Financial Responsibility
Refer to your individual healthcare policy for information on your financial responsibility. Your bariatric out of pocket patient financial responsibility is due prior to your visits/procedure.
Dietary Visits
Dietitian visits will be billed to your insurance and are included during your global period. Post operative self-pay patients dietary visits are included in the self-pay programs. The Dietitian visits are not optional and can only be waived by a medical provider.
Additional Patient Fees
A $30 administrative fee will be charged at each visit when an anorectic is prescribed as an add-on service to a patient’s supervised diet, surgical follow-up and BMI reduction appointments. This fee is collected at the time of check-out.
Usual and Customary Rates
We are committed to providing the best treatment for our patients and we charge what we believe to be reasonable and customary fees for our region and specialty. If your insurance company uses a different fee schedule, you may be responsible for any balance remaining.
Missed Appointments
Unless canceled at least 24 hours in advance, you will be charged $25 for a canceled/missed appointment. Please help us to serve you better by keeping scheduled appointments. This fee is not covered by insurance, so it will be your personal responsibility.
Past Due Accounts
Overdue accounts will be referred to a collection agency. Legal fees that we pay to secure past due accounts will be added to your account. We have the right to terminate you as a patient for non-payment.
Returned Checks
A $40 fee will be charged for checks returned to us unpaid.
Payments
Payment is expected at the time of service. We accept American Express, Discover, MasterCard, Visa, CareCredit, cash, personal checks, cashier’s checks and money orders. No personal checks will be accepted for procedure/surgery payment.
Other Fees
Letters, forms, or any other paperwork to be completed, such as FMLA or disability forms will be charged a fee.
Surgery/Procedure Scheduling Deposit
A $1,000 deposit for self-pay patients and a credit card on file for insurance cases is required before scheduling your surgery/procedure. You are responsible for your out of pocket responsibility prior to your procedure/surgery.
Surgery/Procedure Reschedule/Restart
It is important that when you schedule your surgery/procedure you have thoroughly checked your personal calendar to make sure that your scheduled date is ideal for you. Canceling or rescheduling/restarting your surgery/procedure requires multiple phone calls to the hospital or outpatient facility, insurance company, other patients and many staff members. JourneyLite Physicians will charge a $250 charge each time a surgery/procedure is rescheduled/restarted. This fee will not be applied toward your surgery/procedure and will be added as a charge to your account, not billable to insurance. This fee must be paid to JourneyLite Physicians prior to surgery/procedure being rescheduled. Rescheduling your surgery/procedures could delay your surgery/procedure up to 90 days or more. This fee applies to both insurance and self-pay patients.
Surgery/Procedure Cancellation With No Reschedule
A $500.00 surgery/procedure cancellation fee will be charged to self-pay patients when your procedure is canceled and it is not rescheduled at the time of cancellation (see rescheduling policy above). Patients who cancel their Surgery/Procedure within 72 hours of the scheduled surgery/procedure will be charged a surgery/procedure cancellation fee of $1,000 and will not be eligible to be rescheduled for 90+ days.
Communication I give my permission for The Center of Metabolic and Bariatric Surgery, LLC, JourneyLite Physicians, and JourneyLite Surgery Center to leave messages or send emails regarding confirmation, change or cancellation of my office appointment and or financial information, on an answering machine, with a family member or any adult person answering my telephone. I further give permission to release any medical information, dictation, lab results or billing information about me to any specialist, physician, insurance company, health care agency, persons I identify as authorized, or to myself.
