Missed Appointment and Cancelation Policy
One of our goals is to provide quality OB/GYN care promptly. We understand that emergencies happen, schedules change, and you sometimes must miss an appointment.
Please be courteous and call us as soon as you know you will not be able to attend your scheduled appointment. We can assign your appointment time to a patient with an urgent need.
A missed appointment is when a patient is unable to attend her scheduled appointment and has not canceled her appointment with less than 24-hour notice.
If a patient is delayed by more than 15 minutes, we may ask her to reschedule her appointment.
If a patient misses more than one appointment, we may apply the following actions:
After one missed appointment within 12 months (one calendar year), the patient may receive a warning.
After two missed appointments within 12 months (one calendar year), the patient may be charged a $50 late fee. This fee is sent to the patient directly and is not billable to any insurance company.
After three missed appointments within 12 months (one calendar year), the patient may be dismissed from our practice.
Cache Valley Women’s Center provides its services to you, not your insurance company. Because of this fact, you are responsible for payment of any bill incurred in this office. We cannot provide services assuming that the insurance company will come through with payment.
As a courtesy to you, we will bill your primary insurance company. However, within 60 days we will expect you to pay the balance in full. It will then be your responsibility to collect from the insurance company. We will be happy to send a bill to your secondary insurance company as well. Please be aware that any quote of benefits or coverage is not a guarantee of benefits of payment. Your claim will be processed according to your plan. If your claim processes differently from the benefits we were quoted, the insurance company will side with the plan and will not honor the benefit quote they gave us. Accepting your insurance does not place financial responsibilities onto this practice, and you will be held accountable for any unpaid balances on your plan.
You are responsible for all deductibles and charges not covered by insurance. Please understand that we cannot, as a third party, become involved in prolonged insurance negotiations as that is your responsibility. Please contact your insurance company to inquire if we are a provider for your insurance.
All co-payments and/or percentages that your insurance requires you to pay must be made at the time of the visit. We accept cash, personal checks, and most major cards.
Often our patients find themselves without any insurance coverage. It is our policy that payment is to be made in full at the time of service unless prior arrangements have been made. Any account that has been left unpaid after 30 days will be charged an interest rate of 2% monthly (24% annually) or a minimum fee of
$3.00. In the event that an account is left unpaid, the undersigned agrees to pay costs charged by our collection agency (50% of the unpaid balance) and all limited reasonable attorney’s fees.
By signing your name on the form provided to you by our office, you agree to and understand the above financial policy and you authorize the release of any medical information necessary to process any claim. You authorize payment to be made directly to the doctor from your insurance company(ies). This authorization may be revoked by you or your insurance company at any given time in writing.