For post-operative questions or concerns, please call 913-722-0020 to speak to a Physician Assistant.
We want to thank you for the opportunity to serve you regarding your surgical needs. Following is our surgical financial policy:
Insurance
As a courtesy, we will bill your insurance for you. This service is provided for you as a courtesy only and does not substitute for payment. Many insurance companies pay fixed allowances for certain procedures, while many others pay a percentage of the charge. “Reasonable and Customary Fees” are determined by your insurance carrier and may vary greatly between carriers. It’s your responsibility to pay any deductible amount, co-insurance, co-pay, out-of-pocket or any other balance not covered by your insurance company.
Payment Information
- Your insurance policy is a contract between you and your insurance company. We are not a party in that contract. We file insurance as a courtesy only.
- All charges are your responsibility whether the insurance company pays or not. Not all services are a covered benefit on all contracts. Pre-existing conditions may not be determined prior to surgery and may result in denial or a non-covered benefit. As a courtesy, our staff will do everything possible to prevent any unexpected out-of-pocket expenses to you, but your insurance company is the final decision maker. All charges not covered or denied are your responsibility.
- If you have a deductible, co-insurance, out-of-pocket or copay it is your responsibility.
- Accounts become past due after sixty days. We reserve the right to add a finance charge and send the account to an outside collection source if the balance is not paid in full in the sixty day time frame.
Billing Procedures
Midwest Medical Specialists, P.A., is not a part of any surgical center, hospital or anesthesiologist facility, therefore, you will be receiving separate billing statements from each entity that has provided a service to you.
I hereby acknowledge that I have read, understand and agree to the terms of this document relating to insurance coverage and payment of my bill.
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Authorized Signature (Patient or Legal Guardian) Date
Please print this page, sign and date it and bring it with you to your next appointment