Lifestages Financial Policy

Since the founding of this practice, Lifestages — Samaritan Centers For Women has always offered the most innovative and best medical care possible. In order to continue to do so, the following Patient Financial Policy was implemented.

Self-pay patients: Payment is expected at the time of service for patients who have no insurance coverage. We will give you an estimate of the charges before your visit. We will work with you to develop a payment plan for obstetric care/delivery and surgical procedures.

Insurance patients: You are required to present your insurance card at each appointment. We will verify your benefits and your financial responsibility with your insurance company. Also, as a courtesy to you, we will file a claim with your primary and secondary insurance companies.

While our billing professionals will do all they can to help you in communicating with your insurance plan, you remain responsible for any issues regarding your coverage, benefits, and/or payment for services provided.

Payment of copay and/or deductible is required at the time of service. We will work with you to develop a payment plan for your large out of pocket responsibility for obstetric care/delivery and surgical procedures.

Balance Due: We send monthly statements to inform you of any balance due. We also will remind you of a balance due when you call to schedule an appointment and when you arrive at registration for your appointment. We expect that the balance due will be paid upon receipt of your statement. In order to make payment easier for you, we accept cash, checks, money orders, VISA, MasterCard, Discover and American Express. All forms of payment may be used in our office or mailed in with your statement.

Any balance on your account that is 30 days old will be considered due and it is considered your responsibility, regardless if your insurance company has processed/paid your claim. Any balance on your account that is greater than 30 days old is considered past due. It is our policy to send two statements and a final notice letter before taking further collection action on your account. In the event your account is placed with a collection agency, you will be dismissed from the practice until payment is made in full. (Emergency care will be available for 30 days until you obtain another provider). You will be responsible for all court costs, filing fees, and attorney fees should your account require litigation.

Questions regarding this financial policy should be directed to the Lifestages — Samaritan Centers For Women, Billing Office (937) 277-8988 ext. 5001 or the Practice Administrator at (937) 277-8988 ext. 4138.

6-15-2010