The Northwest Ohio Center for Urogynecology & Women's Health and the Center for Pelvic Rehabilitation & Wellness will be asking you to put a credit card on file (CCOF) effective 4/1/15.
DESCRIPTION:Similar to paying a deposit for a hotel room, having a credit card on file will allow for deposit payment related to visits, procedures, surgery, therapy, and unpaid balances.Patients find this policy respectfully addresses financial responsibility by giving them the courtesy of knowing what charges may be ahead of time. We respect those who may not have a credit card or desire a CCOF, and have developed the policy below to reflect everyone’s situation.
1.Copays are due at the time of service, per office policy.
2. A CCOF will be secured under locked storage (per industry standards) and will not be stored in the patient’s record or computer.
3.Deposits for high deductible office visits orin-office procedures will be reviewed and patients notified of their responsibility in advance. Procedures may require deposits of greater than $300.
4.Surgical deposits will be reviewed based on deductible of insurance policy.This deposit may be greater than $300 due to type of surgery planned.Patients will be notified regarding this amount.
5.For balances post due 60 days, an automatic maximal charge of up to $300 will be rendered. Balances greater than $300 will require patient notification and discussion, with our billing company for payment. Other options for payment such as a payment plan or Care Credit may be offered.
6.Patients may authorize payment for services related to remaining balances at any time utilizing the CCOF.
7.Patient in default past 90 days could have their account sent to a collection agency.
We appreciate your cooperation with this policy. Patient care has always been, and will always be the Centers' #1 priority. It is understood that discussions about healthcare and payment for health services may be emotional and difficult. It is not our intent to cause financial hardship, but to be reimbursed in a timely manner for services rendered.
We know patients value coming to our independent practice because of individualized, specialized care that is sincere in its personal touch. Please assist us in this continual process by reviewing and agreeing to this policy.