We will file with your insurance company as a courtesy to you. However, after 60 days if your account has not been settled, the responsibility will then shift to you. It is our impression that bills should be settled within 60 days and will therefore require that you become actively involved in settling your account.
Please be aware that secondary insurance will be your responsibility to file and collect.
Please be aware that we require payment for all copays, deductibles, and percentages that your insurance will not cover at the time of service.
All supplies are payable at the time of service and cannot be charged. We will file for any covered supplies allowed by your insurance carrier.
There may be a difference between an out of network insurance company’s usual and customary charges and our fee schedule. The patient would be responsible for any difference not paid by insurance. This does not apply to current contracted carriers.
If you cannot keep your appointment for any reason, please call 24 hours prior to your appointment. If you do not show to your appointment or if you cancel without a 24-hour notice, a fee of $40 will be applied. This charge will not be billed nor paid by your insurance.
Please be advised that we are not a credit guarantor. Therefore, failure to maintain these arrangements may result in the placement of your account with an agency or attorney for collections.
You will remain financially responsible for the contracted allowable for services rendered, regardless of the payment option selected above. In the event your account becomes delinquent and is therefore in default of payment, the patient, legal guardian, or admitting parent will be responsible for the principle amount owed and all reasonable costs associated with the recovery of this debt. There will be a $25.00 charge for all returned checks.
Thank you for allowing us the opportunity to serve you. If you have any questions about the above information or any uncertainty regarding your insurance coverage, please ask for assistance.
1526 E. Franklin St. Chapel Hill, NC (919) 967 - 5959