About your Bill

FINANCIAL POLICY

PAYMENT IN FULL IS REQUIRED AT TIME OF SERVICE.

Unless other arrangements are approved by us in writing, the balance on your statement is due and payable when the statement is issued, and is past due if not paid within 30 days.

  1. You may pay by cash, check, or credit card on the day that services are rendered.
  2. Monthly payments plans are available with approval of the patient collections department.
  3. If you feel you may qualify for financial assistance, please contact a patient account representative at 225-743-2600.

Co-payments and Deductibles: Any co-payments / coinsurance and deductibles must be paid at the time of service. This is a requirement of your insurance company. Failure to do so can be considered a breach of contract.

Prompt-pay Discount: We offer a prompt pay discount to uninsured patients who pay in full at the time of service.

Medicare, Medicaid and Private Insurance Plans: You must present a current, valid insurance card at each encounter. We participate in many health insurance plans. You are responsible for understanding your benefits covered under your health insurance plan.

Claims Submission: We will submit your claim for payment. In some instances your insurance company may need you to provide information to the insurance directly. It is your responsibility to comply with their request. Failure to do so could result in a denied claim leaving you responsible for payment.

Returned checks: A fee of $25.00 is assessed for any checks returned by the bank. A certified mail fee may also apply if a check is not paid once re-deposited to the bank. Two or more returned checks will result in the account being placed on a cash only status. Checks reported to the
Justice of the Peace and/or Police Department may include possible discharge from the practice.

Monthly Statement: If you have a balance on your account, we will send you a monthly statement. It will show separately the previous balance, any new charges to the account, and any payments or credits applied to your account during the month.

Past due accounts: If your account becomes past due, we will take necessary steps to collect this debt, including involving outside collection agencies and possible discharge from the practice.

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 reporting agency, the fact that you received treatment at our office may become a matter of public record.

Divorce: In case of divorce or separation, the party responsible for the account prior to the divorce or separation remains responsible for the account. After a divorce or separation, the parent authorizing treatment for a child will be the parent responsible for those subsequent charges. If the divorce decree requires the other parent to pay all or part of the treatment costs, it is the authorizing parent’s responsibility to collect from the other parent.

Transferring of Records: You will need to request in writing if you want to have copies of your records sent to another doctor or organization. You authorize us to include all relevant information, including your payment history. If you are requesting your records to be transferred from another doctor or organization to us, you authorize us to receive all relevant information, including your payment history.

Personal Injury: We do not bill Attorneys or third party payers for personal injuries due to accident or injury.

Effective Date: Once you have signed this agreement, you agree to all of the terms and conditions contained herein and the agreement will be in full force and effect.