Office Policies

Insurance Verification

At each visit, the patient must provide an active insurance card with current, correct information. Without proof of insurance, the patient may be re-scheduled. Renaissance Health and Surgical Associates, P.C. makes it priority to verify proof of a patient's insurance; however, it is the patient's responsibility to know his/her insurance benefits including wellness benefits prior to time of service.

Patient Cost Co-Pays and Co-Insurance

If we are contracted with your insurance company, we must follow our contract and their requirements. If you have a co-pay or deductible, you must pay that at the time of service. It is the insurance company that makes the final determination of your eligibility. If your insurance company requires a referral and/or preauthorization, you are responsible for obtaining it. Failure to obtain the referral and/or preauthorization may result in a lower payment from the insurance company. You agree to pay any portion of the charges not covered by insurance.

Outstanding Balances

Patients will be asked to settle any outstanding balances with Renaissance Health and Surgical Associates, P.C. before their appointment. As a patient, you may pay any outstanding balances at our office, by mail or by phone. Patients with outstanding balances may be declined treatment or exams for non emergency care until the balance are resolved. Patient balances which are not resolved in a timely manner will be sent to an outside collection agency. If the patient's balance is transferred to an outside agency, the patient will be responsible for paying any additional collection fees associated with the collection of the patient balance.

Self Pay

Renaissance Health and Surgical Associates, P.C. recognizes that not everyone has insurance coverage. The initial office visit fee is $150.00, due at the time of service. Although, it is difficult to accurately predict what services a patient may ultimately need, Renaissance Health and Surgical Associates, P.C. will try to work with the patients to help them anticipate charges and mange their healthcare expenses.

Co-Signature

If this or another Financial Policy is signed by another person, that co-signature remains in effect until canceled in writing. If written cancellation is received, it becomes effective with any subsequent charges.

Credit History

You give us permission to check your credit and employment history and to answer questions about your credit experience with us. We have the option to report your account status to any credit reporting agency such as a credit bureau.

Billing Insurance

Renaissance Health and Surgical Associates, P.C. contracts with most insurance companies for patient services. The patient remains financially responsible for all his/her care, but the remaining balance for services rendered to the patient will not be billed to the patient until payment is received from the insurance company(s), the insurance company denies the claim, or the insurance company unreasonably fails to pay in a timely manner. A Statement will be sent to the patient or responsible party. The billed amount on the statement is due in full. A late charge of $0.00 will be imposed on each account that is over thirty (30) days past-due. We determine your account is past-due by taking the balance owed thirty (30) days ago, and then subtracting any payments or credits applied to the account during that time.

No-Show and Late Cancellation Fee

Patients who do not show up on time for an appointment, or cancel appointments with less than 24 hours notice may be subject to a $30.00 fee, not for any service, but for the lost opportunity to see another patient. This fee may be higher for procedures other than routine office visits.
Patients with repetitive no show appointments may be discharged as a patient of this office

Payments

Renaissance Health and Surgical Associates, P.C. accepts cash (no change available), check, Visa or MasterCard. There is a $25.00 fee for all returned checks.
Payment can be sent to:

Renaissance Health and Surgical Asscoiates, P.C.
325 South Cedar Avenue, Ste 2
South Pittsburg, TN. 37380

Note: Patient Accounts with outstanding balances and no payment activity will be forwarded to a collection agency at the patient's expense. In addition to any outstanding balances, the Patient or the Patient's representative who signs our financial policy agrees to pay all costs associated with such collection activity, including reasonable collection agency fees, attorney fees, and court costs.

Transferring of Records

You will need to request in writing, and pay a reasonable copying fee if you want to have copies of your records sent to another doctor or organization. The amount of the fee is dependant upon the number of pages we need to copy. You authorize us to include all relevant information, including your payment history. If you are requesting records to be transferred from another doctor or organization to us, you authorize us to receive all relevant information, including your payment history. .

Waiver of Confidentiality

You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit bureau agency, the fact that you received treatment at our office may become a matter of public record.

© Published in 2018 by Arden Azar
Property of Renaissance Health and Surgical Associates

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