Cornell Family Medicine Financial Policy
Copays: If a copay is required by your insurance policy for the services rendered on the day of your appointment, we request you pay the entire copay at your appointment. As each policy may have a vastly different copay requirement, we do ask that you review your policy or contact your insurance company to understand your policy’s requirements. Cornell Family Medicine cannot waive a required copay as it does violate our contract with your insurance company.
Forms of Payment: Cornell Family Medicine accepts the following forms of payment: cash, check, money order, debit card, Visa, MasterCard, American Express, and Discover cards.
Insufficient Funds: Due to the amount of time it takes our staff to handle a bounced check, a $25.00 service
fee will be charged for any checks returned for insufficient funds.
Insurance Plans: Cornell Family Medicine (CFM) bills your insurance plan as a courtesy to you. As a courtesy to us, we ask that you provide to the CFM your correct and current insurance information at each and every appointment, including secondary insurance if you have that. As you might expect, if we do not receive accurate insurance information from you, we will simply bill you the full amount of the charges for the services provided to you. You certainly may then bill the correct insurance company to cover any fees you had to pay to us. If you are able to get accurate insurance coverage information to us within 45 days of your appointment, we will bill your insurance company directly.
In addition, we work with many different insurance plans, and each may have several policies. We are unable to know which services your insurance plan and policy cover. We ask that you understand what your plan and policy cover prior to your appointment as not all services are covered by every plan. Those services not covered will be billed directly to you. Your insurance policy should be helping you understand their covered services.
No Insurance: We strongly encourage all patients to have health insurance coverage at all times. If you do not have coverage, we will still be happy to see you. We provide a self-pay discount, but we require payment in full at the time of the appointment.
Missed Appointments: We wish to provide timely and appropriate appointments for all of our patients. We value our time with you as you do with us. Please provide us with a 24-hour notice for any cancelled or changed appointments so that we can use that time slot for another patient who needs to be seen that day. We reserve the right to charge $35 for non-emergent missed appointments. Multiple missed appointments may result is dismissal from the clinic.
Outstanding Balances: For our patients who have an outstanding balance after one statement has been sent to them, we offer a payment plan in lieu of being sent to collections. Contact our billing service at 503.266.7600 for more information.
Collections: We bill our patients monthly for any outstanding balance. We request you satisfy your outstanding balance on receipt of the monthly statement. If you are unable to do so, we request you contact the billing department immediately to set up a short-term payment plan. If neither are done, or the requirements of the payment plan are not met, we will turn your account over to collections. If we must turn your account over to collections more than once, we deem that grounds to terminate our medical relationship with you.
Laboratory Services: We are happy to provide lab drawing services within our clinic. We bill your insurance for drawing your blood. We do not bill your insurance for processing your lab specimen. You will receive separate bill from the lab based on the services provided.
Motor Vehicle Accident: Due to vast experience with difficulty getting properly reimbursed for medical care provided to our patients for injuries from a motor vehicle accident, we respectfully request each patient to pay for their medical care related to a motor vehicle accident on the day of their appointment. We will provide all the necessary paperwork to our patients as needed so that each patient can be reimbursed directly from the motor vehicle insurance carrier.
Phone Numbers: Please keep us up-to-date with your phone number and address so that we may get test results and other information to you in a timely fashion.
Physicals/Wellness Exams: Most insurance companies allow a physical or wellness exam at no charge to you (no copay is required) once a year. But a few policies, especially for younger patients, may allow these exams only once every other year. Please be sure you know what your insurance company allows and make it very clear to your provider so that we can document your appointment and bill your insurance correctly.
Physical exams (or wellness exams) are intended to screen for disease but not necessarily treat it at that appointment. Traditionally, for your convenience, we have provided this screening physical exam AND also addressed your chronic conditions in the same appointment. What we have overlooked, was that we were to bill your insurance for a separate office visit if any medical problems were also addressed (depression, hypertension, diabetes, heart disease, acute infection, chronic pain, etc…). We now are to bill your insurance for this separate office visit and require a COPAY from you. We regret this is the state of health care at the moment for all of us.
Medication Refills: Most medication refills can be processed within 24 hours and get processed the easiest if you request the refill from your pharmacy instead of from us. We do require our patients to be seen at the doctor’s discretion if we prescribe medications for them. If your medication prescription is a controlled substance, please allow us 48 hours to prepare your prescription.
Statements: Statements will be sent to you monthly by the billing team.
I give my permission for the Cornell Family Medicine PC to bill my insurance for all services rendered at Cornell Family Medicine PC.
I have read and understand this office policy and agree to comply and accept the responsibility for any payment that becomes due as outlined previously.
Patient Name(s)______
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Responsible Party Member’s Name Relationship
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Responsible Party Member’s Signature Date