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MasterCare Medical Center 12 Sammy McGhee Blvd Suite 101 Jasper, Ga 30143 Financial Policy MasterCare Medical Center appreciates the confidence you have shown in choosing us to provide your health care needs. The service you have elected to participate in implies a financial responsibility on your part. The responsibility obligates you to ensure payment in full of our fees. Insurance Cards You will be asked to provide your insurance card(s) at every visit. This is to ensure that the information we have is correct. Out of date insurance cards with incorrect information or the wrong insurance cards can cause unnecessary delays in the payment of your claim. Frequently, small changes (group number or plan changes) are not considered significant by patients, but insurers will not process claims that are not 100% accurate. Please review your insurance card every year (it might be the same insurance company and the same group but some benefits might have changed). Please present your card at every visit. CO-PAYS All office co-pays are to be paid at the time of service. This is an insurance company policy. If the co-pay is not paid at the time of service, you will be assessed a $5 late fee. We accept cash, checks, Master Card and Visa. If you pay in cash at the time of service please request a receipt. Exact change is appreciated; we do not keep large amounts of cash at the office overnight. We do not accept bills over $20. Insurance Claims We will submit claims for our patients; however, the agreement of the insurance carrier to pay for medical care is a contract between you and the carrier. You should direct any questions and/or complaints regarding coverage to your insurance carrier, your employer (group plan), or your agent. Insurance Policies vary in their coverage and it is the patient’s responsibility to understand his/her medical benefits. Very few insurance policies pay “everything” at 100%. There may be limitations and exclusions to coverage. The patient portion is set by the insurance company. Patients are responsible for any co-pays, deductibles and any other non-covered billable services. Read your Explanation of Benefits carefully. The EOBs explain what portion of the charges is the carrier’s responsibility and what portion is the patient’s responsibility. We do not bill third parties. It is the responsibility of the patient to satisfy any outstanding balances. We will provide statements as proof of payment for patients to pursue reimbursement from the third party payers. When you receive a statement from MasterCare Medical Center, and it shows that a date of service has still not been paid for by your insurance company (we will highlight for your convenience), please take a moment to call your insurance company and question the lack of payment. It is your insurance, and they will respond quickly to your questions. If you find out about information we need to address, please call us immediately. Your help in this matter insures that we will continue the file insurance. Payments We accept cash, checks and credit cards. In addition to mailing in your payment, credit card information may be called into the billing office from 8:00am to 4:00pm. Patient invoices are sent after insurance payments are received. Balances are due within 28 days of receipt of the invoice. If the balance remains unpaid after 28 days, a late charge of 1.5% per month is applied to the account. Your account will be sent to collections if balance remains unpaid after 90 days. You will be charged 35% collection fee and /or attorney fees. Return Checks If a patient’s check is returned to us by the bank or a credit card payment is denied, a $38.00 fee is assessed on the account. Cancellations and No-Shows We understand that there are times you will miss an appointment due to an emergency or work and family obligations. We urge you to call 24 hours prior to you appointment or as soon as you find out. MasterCare Medical Center will charge a $25 fee for a No show or late cancellation of your appointment. If there are repeated cancellations and noshows, the patient can be discharged from the practice and will be notified via certified mail. Annual Physical Exams MasterCare Medical Center recommends a physical exam to all our patients annually. An annual physical exam is the best way to find out about problems before they become serious. Many medical conditions including cancer, diabetes and HTN do not have symptoms until late in the disease process. Having a yearly physical exam is an opportunity to catch up on preventive services and immunizations that are usually not discussed on your routine visits. If you are scheduled for an annual physical exam and you do not call within 48 hours to cancel, a $50 charge will be applied. Your financial responsibilities for your annual physical exam will be explained to you prior to the exam.l Worker’s Compensation If you are being seen in the office for a work related injury, you will need to provide us with the name of the adjuster, name and contact information of your supervisor, a claim number and the address where the bill needs to be sent. If you fail to give us this information, you will be responsible to pay prior to the visit. Medical Forms Charges to complete medical forms are not covered by the insurance and are therefore the responsibility of the patient. Fees vary according to the length and complexity of the form and you may ask the staff for that information. Medical Records Medical records for insurance or legal purposes do have a charge. Our receptionist will have the fee available to you at your request.