Hcr 230 Wellness Medical Practice Paper

HCR 230

Wellness Medical Practice

Part A

Wellness Medical Practice welcomes you as a patient. The practice strives to provide its patients with excellent healthcare. In order to keep the cost of our medical services comparable with other medical providers in the area, Wellness Medical asks patients to become familiar with the practice's Financial Policy.
PAYMENT: Each office visit payment is rendered at that time, unless prior payment has not been arranged with billing staff. Payments are listed as co-insurance and co-pays for their insurance holders. Wellness Practice accepts all monetary payments debit and credit cards. A $25.00 return check fee will be applied to account. An outstanding bill that is over 60 days will be required to
MISSED APPOINTMENTS/LATE CANCELLATIONS: Missed appointments could keep another patient from being seen by their physician. Therefore, if Wellness Medical Practice does not receive a cancellation of 24 hour before your appointment time the patient will be charged a no show fee of $50.00.
If you don’t understand any part of this financial policy, please contact us at (XXX) XXX-XXXX anyone in our billing department can answer your question.
I understand the document set forth to me by Wellness Medical Practice Policy. Under this policy all benefits will be paid directly to Wellness Medical. Wellness Medical has my permission to release my medical information to process a claim. In the event my account becomes delinquent this office will turn the account over to collections. I am aware I will continue to be responsible for all charges accrued through the collections agency.
I agree to the Wellness Medical Practice's Financial Policy.
Signature: ___________________________________
Name: _____________________________________
Date: