PHONE: 248-922-6000

FAX: 248-922-5997

 
Town Center Foot & Ankle

6510 Town Center Dr. Suite C Clarkston, MI 48346

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Patient Insurance Financial Responsibility Policy
 

We at Town Center Foot and Ankle are committed to providing you with the best possible care and are pleased to discuss our professional fees with you at any time. Your clear understanding of our Financial Policy is important to our professional relationship. Please ask if you have any questions about our fees, financial policy or your financial responsibility.
 
· INSURANCE COVERAGE - Your insurance policy is a contract between you and your insurance. As a courtesy, we will file your claim. However, the patient is required to provide us with the most correct and updated information about their insurance, and will be responsible for any charges incurred if the information provided is not correct or updated. If you have Medicare and a secondary insurance, please be sure to provide your secondary insurance information as well.

· REFERRALS – If your plan requires a referral from your primary care physician, it is YOUR responsibility to obtain it prior to your appointment and have it with you at the time of your visit. If your plan requires a referral and you do not obtain one, you will be held responsible for the visit charges in full at the time of service.

· OUT OF NETWORK PLANS – You are responsible for contacting your insurance to determine if we are in network with them. Although we may participate with your insurance, some plans may not be in network.  You will be responsible for any balance your plan indicates as due on their explanation of benefits form. We will adjust the charges to coincide with your plan’s UCR (Usual, Customary and Reasonable) charges; you will be responsible for the full amount due. Should you receive payment from your insurance carrier, please forward it to the physician’s office.

· DEDUCTIBLES/CO-INSURANCES – All patients will be responsible for knowing their co-insurance and deductible.

· CO-PAYMENTS – By law we MUST collect your carrier designated co-pay. This payment is expected at the time of service. Please be prepared to pay the co-pay at each visit.

·SELF-PAY PATIENTS – Payment is expected at the time of service unless financial arrangements have been made prior to your visit.

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By signing below, you understand that although Town Center Foot and Ankle will make every effort to assist you with your insurance claims, patients are responsible for full payment for all services rendered. You are responsible for the timely payment of your account. For your convenience, we accept checks, cash or credit card payment.
 

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