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Southland Rheumatology Billing Form

Billing Policy:

Billing Policy:

  • Patient benefits will be verified with insurance prior to your office visit and co-pay will be collected at the time of service by cash or credit card (NO CHECKS).

    •  ALL CO-PAYS ARE DUE AT THE TIME OF SERVICE.

    • Deductibles will be collected in full at the time of follow up appointment, after insurance has processed claims.

  • Patients with outstanding balances will be requested to pay the balance in full, prior to theirappointment, by cash or credit card (NO CHECKS).

  • If amount remains unpaid after 90 days, the account will be referred to collection agency and an additional 10% fee will be applied to cover collection fee.

No Show / Cancelation Policy:

No Show / Cancelation Policy:

Any cancellation for an appointment without a 24-hour notice, depending on the circumstances of course, there will be charge a $25, that will have to be collected at the time of your next visit by cash or credit card. If you do not show up for an appointment, there will be a $25 charge, that will have to be paid at the time of your next visit. If you do not show up/cancel an appointments 3 times consecutively, we will not be able to schedule any further appointments with our practice.

Notice to All HMO Patients

Notice to All HMO Patients

It is the patient’s responsibility to obtain valid updated referrals for each office visit. If for some reason you do not have a referral to cover services here in our office, your appointment will be cancelled. Any office visits that do not have a referral to cover the services, the patient will be responsible for any balance, which your insurance will not cover without having a referral.

Note:

Note:

If you need to cancel your appointment prior to the scheduled date, and we are not in the office, you are always welcome to leave a message with our answering service at 708-283-2600.
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