Financial Policy


 

FINANCIAL POLICY
Our goal is to offer our patients quality health care services at affordable rates. You can help us by providing us accurate, up-to-date information about your third-party health care payers each time you visit the clinic. Please bring your current ID and insurance card to each visit. Insurance Carriers are often changing ID numbers, scope of covered services and pre-authorization requirements. Maintaining accurate information on your account helps reduce the administrative costs of the Clinic.

  • It is the patient’s responsibility to verify that we are participants (in network) with his/her insurance plan.
  • The patient is responsible for co-pays, coinsurances and any other portion of the bill not covered by their insurance plan.
  • All elective procedures not covered by insurance must be paid for in advance or on the day of service, unless payment arrangements have been agreed upon.
  • Any unpaid balances on your account are due within 30 days of service. Please contact us to make payment arrangements if you are unable to pay the remaining balance in full.
  • We reserve the right to add a $25 charge to your account for missed appointments or those cancelled less than 24 hours in advance.
  • Multiple cancellations and/or missed appointments may result in discharge from the practice.

STATEMENTS: Payments should be mailed to 5390 E. Erickson Dr., Tucson AZ, 85712, attention “Billing Department”. If you have any questions please call 520.777.3819.

MEDICARE: You will be responsible for the “Patient Responsibility” portion of the fee, as outlined on your Medicare Explanation of Benefits. You are also responsible for any services deemed “non-covered” by Medicare. We will also bill secondary insurance for services as a courtesy to our patients.

INSURANCE: QLMC will submit claims to ‘Primary’ insurance plans according to the terms of the individual agreements with the insurance company when they exist. We will also bill secondary insurances as a courtesy to our patients. However, if payment is not made by the secondary insurance within 60 days of submission, you will be responsible for any balance due.

PLEASE NOTE: you will be responsible for non-covered services per your insurance contract.

PAYMENT ARRANGEMENTS AND COLLECTION: It is your responsibility to make payment for services rendered.
If you are unable to make payment in full, it is important that you contact our billing office to make payment arrangements for your account. Anyone who is making regular payments on their accounts via a “payment agreement” will continue to receive all services provided by the Clinic.

If NO payment is received, or if payments are untimely, a collection agency may be utilized. Only emergent care will be provided once your account is sent to the collection agency and your account remains unpaid. Once your account is paid in full, you again will have access to all of the services provided by the clinic as long as you continue to make your co-payments at the time of service and/or pay the entire cost of your self-pay appointment at the time of service.

PLEASE NOTE: Patients, who have not made regular payments in three (3) months, and who have not contacted our Billing Department to make payment arrangements, will be dismissed from the practice.

SELF-PAYMENT ACCOUNTS: Self-pay account payments are due at the time of services. Self-pay patients will be asked to pay for a new patient visit, which ranges from $105 to $230, depending on the time and extent of the appointment. Discuss the fee at time of appointment scheduling. Payment is due at the time of appointment. Any additional services provided, as a courtesy, will be billed to you. It is the patient’s responsibility to contact our Billing Department if unable to pay the account in full.

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