Welcome to Vista Surgical Group. We are committed to the goal of providing you with high quality care and partnering with you to have a strong physician-patient relationship. A part of that relationship is a clear communication of financial policies and allows us to provide you with cost-effective care. The following is a statement of our Financial Policy that we require you to read and sign prior to any treatment.
Insurance
We will gladly bill your insurance company directly if you provide us with all the necessary information to do so. Your contract for health insurance is between you and your insurance company. The services you receive and the bill for those services is an agreement between you and Vista Surgical Group. It is ultimately your responsibility to see that your bill is paid in full. Agreements with insurance companies vary greatly and it is your responsibility to know what portions your insurance is paying on your behalf and what portion you will be paying out of pocket. Any remaining money unpaid by your insurance company will be your responsibility to pay in a timely manner. If your insurance company does not pay in a timely manner, it will be your responsibility to contact them.
Prior to receiving any treatment, you will be required to provide us with your current health insurance card and a driver’s license or another acceptable form of ID. You are responsible for making complete insurance information available to Vista Surgical Group for accurate claims filing. Complete insurance information includes current insurance cards (primary, secondary and/or tertiary), proper identification, and referrals from other providers if applicable based on your health insurance requirements.
Not all services our office provides are covered by every health insurance plan. Any service determined NOT to be covered by your plan will be your responsibility.
If you do not have health insurance coverage, choose to bill your own insurance, or if our physicians do not participate in your health insurance plan, payment IN FULL is due at the time of service. Acceptable forms of payment are check or credit card.
Copays, Co-insurance and Deductibles
Copayments, co-insurance and deductibles represent the portion of our services that patients must pay out of pocket. Such payments are required by your agreement with your health insurance company, and our contracts with insurance payers require us to collect them. You are responsible for checking with your insurance plan regarding any co-payment, deductible or co-insurance you may owe at the time of service.
Vista Surgical Group requires payment of your copay, co-insurance and deductible in full prior to or at the time of services. If copay, deductible or coinsurance is not paid your appointment, procedure or surgery will be rescheduled.
Credit Card on File Policy
Vista Surgical Group is committed to making the billing process as simple and easy as possible. We require that all patients provide a credit card on file with our office. We will scan your card with a card reader. It will store your card number in a secure, compliant location in your electronic medical record. Credit cards on file will be used to pay copays when you are seen in our office, including account balances, after your insurance processes your claims.
If we do not receive payment for the amount listed on your statement within 15 days, we will run the credit card on file for the full amount owed. If your payment is declined, we will call you. If our reminder call is not returned within one week, a $35 declined payment fee will be applied, and another statement will be sent. Your account will become delinquent if not paid within 30 days after the original statement. The unpaid balance will be subject to collections with finance fees.
You give Vista Surgical Group permission to charge your credit card for any patient balance due on your account. If you have insurance coverage, your card will be charged AFTER your insurance has paid their portion.
No shows and late cancellations
In an effort to serve our patients and the community well, we must utilize our time efficiently. When a patient makes an appointment, time is set aside for their needs, and work is performed to prepare their record for the visit. When a scheduled visit is not completed, there is a loss for another patient who could have used that available time, as well as wasted staff time. Therefore, we ask that when a scheduled visit cannot be met, it be cancelled at least forty-eight hours prior to the time of the appointment. For late cancellations or not showing for a scheduled appointment, a $50 fee will be charged for established patients. For new patients, a $100 fee will be charged.
Referrals
Many insurance companies require a referral to a specialist prior to any appointment. It is your responsibility to determine if a referral is required by your insurance company and to ensure that this referral is obtained prior to any scheduled appointments. To obtain a referral you will need to contact your physician and request one. Failure to have a referral on file in our office prior to your appointment will require payment in full at the time of service, or for the appointment to be rescheduled.
Miscellaneous
Vista Surgical Group is committed to providing the best treatment for our patients and we charge what is usual and customary for our services and area. You are responsible for payment regardless of any insurances company’s arbitrary determination of usual and customary rates. Please be aware that some, and perhaps all, of the services provided may be non-covered services and not considered reasonable and necessary under the Medicare Program and/or other medical insurances.
For all scheduled appointments, prior balances must be paid prior to the visit.
A $35 fee will be charged for any checks returned for insufficient funds, plus any bank fees incurred.
A $35 fee is required to complete patient forms regarding disability insurance, life insurance and FMLA.
If you undergo a surgical procedure, in addition to a bill from your surgeon, you may also receive bills from the hospital or surgical center, the anesthesiologist, pathology/lab and/or radiology, depending on the procedure. Vista Surgical Group and our billing partners can only discuss with you or have knowledge of the bill related to our services.
