Thank you for choosing Dr. Horbal as your Allergy and Asthma specialist. We are committed to your successful treatment. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our Financial Policy which we require you to read and sign prior to any treatment.
Regarding Your Insurance Coverage
All patients must complete our information and insurance from before seeing the doctor. It is the guarantor’s responsibility to provide us with the most current insurance information. If the policy should change, please notify us immediately. We will need this information to accurately bill your insurance(s) for the services rendered at this office. If insurance information is not provided to us at times of service, charges will become the responsibility of the guarantor. If insurance coverage requires a referral for services, it is the responsibility of the guarantor to obtain it.
After current insurance information is received, we will bill your insurance for the services rendered. Any secondary insurance will be billed after the primary insurance has responded.
Once the secondary insurance has responded, we will transfer copays, deductibles, and non-covered charges to the patient balance. This balance is the responsibility of the guarantor. For any insurance company that pays the subscriber directly, the subscriber/guarantor is required to forward the explanation of benefits and any payment directly to the office.
If there are problems or denials from the insurance company, it is up to the guarantor to negotiate the problems with the insurance company. Dr. Horbal is treating the patient, not the insurance company. Your insurance policy is a contract between you and your insurance company; we are not party to that contract.
It is important to note that any balance over 60 days old may be placed with a collection agency and/or Credit Bureau. Therefore, if for any reason you are unable to settle your account within 30 days, it is imperative that you contact our Business office immediately. Do not assume that the balance on your statement will be paid by your insurance company. The balance on your statement is from non-covered services, copayments, or deductibles after the insurance has considered the charges. Please call to correct any billing errors immediately. If you ignore our billing statements, we will assume that you do not intend to pay for the medical services that were provided in good faith.
If it becomes necessary to pursue collection with an outside agency, the patient will be charged the total amount of the collection fees, attorney fees, and allowable court fees. The patient will also be discharged as a patient of Dr. Horbal.
Usual and Customary Rates
Our practice is committed to providing the best treatment for our patients, and we charge what is usual and customary for our area. You are responsible for payment regardless of any insurance company’s arbitrary determination of usual and customary rates.
The adults accompanying a minor, and the parents/guardian, are responsible for any payment due to the account. If financial responsibility for a child is affected by court orders or divorce decrees, payment is expected from the guarantor that accompanied the child and signed the required forms. Collecting balances from another parent is not our responsibility. It is between the parents and the court. Our office will not be involved. Statements are mailed to one address only. For unaccompanied minors, non-emergency treatment will be denied without a prior written and signed authorization from a parent and/or guardian.
Unless canceled at least 48 hours in advance, our policy is to charge for revisit/checkup appointments at the rate of a normal office visit. Please help us serve you better by keeping scheduled appointments. Special appointments, such as allergy retesting, will be charged a $200.00 cancellation fee.
Thank you for understanding our Financial Policy. Please let us know if you have any questions or concerns.