Self-Pay Financial Policy

The following policy outlines payment expectations for uninsured patients or those with out-of-network plans.

Good Faith Estimate (GFE)

In accordance with federal transparency requirements, patients scheduled for non-urgent and non-same-day appointments will receive a Good Faith Estimate (GFE) of expected charges.

  • The GFE will be sent via email within three (3) days of scheduling the appointment.
  • The estimate reflects the anticipated cost of services with our prompt pay discount applied and is based on the information available at the time of scheduling (see below for more details).
  • Actual charges may vary depending on the services actually provided.

Prompt Pay Discount

We offer a Prompt Pay Discount for self-pay patients who pay their balance within 3 days of service.

To qualify for the discount:

  1. The patient or family must not have any existing balance with the practice.
  2. Payment in full must be received within three (3) business days of the date of service.

Card on File Requirement

All self-pay patients are required to maintain a credit card, debit card or HSA card on file (COF).  The card on file will be used to process balances related to services provided.

  • Maintaining a card on file helps streamline billing and allows patients to take advantage of prompt-pay discounts.

If payment with COF fails, AND a new COF is not provided within 3 days of service, the prompt pay discount will not apply and full charges will be billed and due within 30 days.

Patients who do not have a credit card or decline to keep a card on file must prepay at check-in using cash, based on the Good Faith Estimate provided.

Additional Charges

The Good Faith Estimate reflects anticipated services only. If additional services, testing, procedures, or extended care are required during your visit, additional charges may apply and will be billed accordingly.

Questions

If you have questions about your estimate or financial responsibility, please contact our office prior to your appointment. We are happy to assist you in understanding your expected costs.