Financial Policy

Thank you for choosing SurgOne, P.C. for your health care.

To achieve our goal of providing and maintaining a good physician-patient relationship, we believe it is important to have solid financial policies in place. We also believe that these policies will allow us to provide our patients with high quality, cost-effective care. We ask that you carefully read and sign the following SurgOne, P.C. Financial Policy prior to your treatment.

• Upon arrival, please sign in at the front desk and present your current health insurance card as well as your driver’s license or another acceptable form of ID. You may be asked to present both items at each visit for proper identification.
• If you do not have health insurance coverage, choose to bill your own insurance, or if our physicians do not participate in your health insurance plan, payment IN FULL is due at the time of service. Acceptable forms of payment are cash, check, VISA and MasterCard.
• You are responsible to make complete insurance information available to SurgOne, P.C. for accurate filing of claims. Complete insurance information includes current benefit cards (primary and secondary), proper identification, and referrals from other providers if applicable.
• You are responsible for checking with your insurance plan regarding any co-payment, deductible or co-insurance that you may owe at the time of service.
• Co-payments are a contractual obligation with your insurance company. You are required to pay your co-payment, and we are required to collect your co-payment at the time of each visit. Co-payments are collected prior to service.
• If the insurance information that you provide at the time of your visit is incorrect, you will be responsible for payment of your visit and to submit the charges to the correct plan.
• For indemnity-type health insurance plans, insurance payments received by SurgOne, P.C. will be applied to your account and you agree to pay the balance.
• If you have a HMO or PPO health insurance plan and our SurgOne, P.C. physicians participate in your plan, we will accept payment from the carrier for services covered by your benefit plan.
• Not all services provided by our office are covered by every health insurance plan. Any service determined NOT to be covered by your plan will be your responsibility.
• SurgOne, P.C. is committed to providing the best treatment for our patients; however, you are responsible for any unpaid balance regardless of your insurance company’s arbitrary determination of usual and customary rates.
• For scheduled appointments, prior balances must be paid prior to the visit.
• We require 48-hour notice for canceling any appointments. A cancellation fee may apply.
• A $20 fee will be charged for any checks returned for insufficient funds, plus any bank fees incurred.
• A $35 fee is required for the completion of patient forms regarding disability insurance, life insurance and FMLA.
• If you undergo a surgical procedure, in addition to a bill from your surgeon, you may also receive bills from the hospital or surgical center, the anesthesiologist, pathology/lab and/or radiology, depending on the procedure.
• If you have a surgical procedure that requires the use of a surgical assistant, SurgOne, P.C. will not bill for those services unless the surgical assistant is an employee of SurgOne, P.C.. You will receive a separate bill from the surgical assistant. Most insurance companies do not have contracts with surgical assistants, therefore your assistant may be out of network. The surgical assistant may or may not be covered by your health insurance plan. If you have specific questions regarding surgical assistant services or whether an assistant will be required for a specific surgical procedure, please let your provider or the staff know.
• IT IS YOUR RESPONSIBILITY TO KNOW YOUR HEALTHCARE BENEFITS AND COVERAGE LIMITATIONS.

We will be happy to address any questions you may have after reading our SurgOne, P.C. Financial Policy. Please let our staff know if you would like a copy of this policy.