Shawnee Medical Center Clinic, Inc. Physicians are committed to providing you with the best possible care. Our Business Services Department is committed to 100% customer service. We want to ensure that you receive the maximum allowable benefits from your medical insurance. In order to achieve this goal, we need your assistance and understanding of our credit policy.

PATIENT RESPONSIBILITY

Patients are responsible for all charges resulting from treatment provided by Shawnee Medical Center Clinic, Inc. As a service to our patients, the Clinic will file claims with most insurance carriers directly, however, you are primarily responsible for services rendered. In cases where we accept "Assignment of Insurance", deductibles and co-insurance are expected at the time of service. We accept cash, money orders, personal checks, Visa, MasterCard or Discover. Patients have the right to dispute or clarify any billing issues by contacting the Business Office Patient Accounts Department.

We will process patient charges as follows:

SELF-PAY/NO INSURANCE: Payment is due at the time services are rendered, unless special payment arrangements have been approved in advance by our Business Services Department.

MEDICARE: Our Physicians are participating providers of Medicare. Patients are responsible for their yearly deductibles and co-insurance. All Medicare supplemental insurance will be filed.

COMMERCIAL INSURANCE: As a courtesy to you, we will file your primary, secondary and other insurance. Deductibles and co-insurance are due at the time of service. You must provide correct insurance billing information, along with a copy of your insurance card on each visit.

HMO PLANS: Co-payments, if required by your plan, are due on each visit. Patients are financially responsible for visits to the Clinic that are not covered by their plans. HMO plans that the clinic does not participate with will be the financial responsibility of the patient.

PPO PLANS: The Clinic will file claims directly to your PPO insurance. Deductibles, co-insurance and co-payments, if required by your plan, are due at the time of service. Patients are responsible for visits to physicians not on their plans. Please check before you schedule your appointment to see if the physician is a participating provider with your PPO insurance.

WORKERS' COMPENSATION: You will need to provide us with the name of your Work Comp carrier, the date of your injury and your claim number (if available). It is important to notify us at the time of your appointment if the visit is related to an injury covered by Workers' Compensation.

MOTOR VEHICLE OR OTHER LIABILITY CLAIMS: The Clinic will file your personal health insurance if allowed. The clinic will not pursue payment from the third party. Payment for out of pocket amounts will be due the date of service.

CHAMPUS/TRICARE: The clinic does not participate with this insurance. Only when instructed by the physician will this insurance be accepted.

*If you are unable to keep your scheduled appointment please provide at least 24 hours advance notice or a fee may be applied.

THE CLINIC PHYSICIANS APPROVE AND SUPPORT THIS CREDIT POLICY.