Office Policy Regarding Insurance
To preserve the best possible relationship with you, our patient, and to prevent any misunderstanding, we hope the following explanation of our office policy regarding insurance and payment for services is helpful.
1.) We expect and appreciate payment for office visits at the time of service. We will accept cash, check, MasterCard, Visa, or debit cards.
2.) For any insurance plan that requires authorization from a primary care physician, (e.g. HMO, PPO, etc.), it is your responsibility, (as patient or guardian), to be sure that this office receives all necessary referrals or authorizations PRIOR to treatment. If the insurance carrier denies any charges due to lack of referral authorization, you, (the patient), are responsible for all charges incurred.
3.) If any type of supplies are dispensed during the course of treatment, (e.g. arch supports, accommodative pads, creams, surgical shoes, etc.), payment is due at the time of service. We cannot bill you or the insurance company for these supplies.
4.) I have read, and understand and agree to the above office policies and understand that I am financially responsible for any balance due on my account.
5.) I hearby give permission to the Boston Common Podiatry to administer treatment and to perform such procedures as may be deemed necessary in the diagnosis and/or treatment of my foot condition and authorize disclosure of medical information to assist in processing my insurance claim and to communicate with treating physicians. Furthermore, I assign all payment of medical benefits provided by my insurance company policy for medical/surgical care to Boston Common Podiatry.
6.) You are responsible for giving the office 24 hour notice of cancellation. If you cancel or miss an appointment, you will be charged a fee of $50 which will need to be paid before you can reschedule or make a new appointment. The Office does have a date and time-stamp voicemail system when messages are left after hours.