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1200 South Rogers Street Bloomington, IN 47403 812.339.6434

About Us

OFFICE POLICIES

Billing Information

We will submit claims to most insurances as a courtesy to you at the time of service. To do this we must have your current insurance card with all the necessary information. The balance becomes your responsibility 45 days after the filing date, unless we are under contract with your insurance company. If your insurance considers a service to be non-covered, you will be responsible.

Co-pays and deductibles must be paid at the time of services. If you are a Champus/Tricare patient with no other insurance coverage, payments are due at the time of service.

A down payment of $100.00 is necessary for surgical procedures at the time of service. The balance will be submitted to your insurance company or billed to you. If your insurance pays in full, the credit will be refunded to you. Payments for cosmetic procedures are due in full at the time of scheduling.

Your account will be placed with our collection agency, Allied Collection Services, in the event that the entire balance has not been paid in full within 90 days from your insurance responding.

The patient will be responsible for all fees including attorney fees and court costs.

We accept cash, checks, money orders, Visa, Discover, Mastercard, and American Express.

Medical Record Policies

All information regarding you the patient is confidential. Please advise our staff of anyone, other than the patient, that may obtain your medical information. We must also have a release of medical information form signed by you. There is a $15.00 medical record fee for copying and sending brief medical records. Please understand it may take 10 – 14 business days to process your medical records.

Your Responsibilities Regarding Charges and Insurance:

We would like to share the following policies with you so that you understand your responsibility regarding the charges for the services rendered to you by this office:

Know if we are a provider for your insurance company:

  • We will file both your primary and secondary insurance as a courtesy to you. If we do not receive payment from your primary carrier within 60 days of filing, you will be billed for the entire amount.

  • If you only have primary insurance, you will be asked to prepay 35% of the entire bill at the time of service. Any amount not paid by your insurance company will be billed to you.

  • A $100.00 down payment is necessary for surgical procedures and should be paid at the time of service.

Please understand that because we do not have a contract with your plan, we are not obligated to adjust our charges based on your plan’s coverage or benefits. The entire balance remaining after your primary carrier has paid will be your responsibility.

We are not on assignment with Champus, thus payment is expected at time of service. A claim will be sent to your insurance and Champus will reimburse you.

If we participate (are contracted) with your insurance plan under which you are covered, we will bill the carrier for all charges for services rendered. We will bill both your primary and secondary insurance plans for contracted plans. You will be responsible at the time of service for payment of:

  • The annual deductibles
  • Co-payments
  • Charges for non-covered or cosmetic services

Provide your insurance card so we may file a claim:

We will not submit a claim to your insurance without a copy of the insurance card. You will be considered a Self-Pay patient and be expected to pay for the entire bill at your visit.

Find out if your insurance will pay for your visit or procedure:

In the event that you are not aware of the charges that are not covered by your plan, you will be billed for the balance after we obtain a denial from your insurance carrier.