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The following information is important for our patients to read BEFORE their visit to Heritage Internal Medicine.

 

Appointment Policy:

*Please arrive 15 minutes prior to your scheduled appointment time. This will allow time for check in and proper documentation to be filled out.

*Please bring two (2) forms of ID and all medications with you to every appointment.

*Please be aware that if you are late for your appointment, you may be asked to reschedule.

*If you need to cancel your appointment, please call 24 hours prior to your appointment time. If you do not call prior to the appointment to cancel or reschedule, you will be considered a no show.

 



No Show/Missed Appointments

*First no show: You will receive a $25.00 no show charge.

*Second no show: You will receive a $50.00 charge for missed appointment.

*Third no show: A third no show could result in dismissal from the practice   and/or a $75.00 charge for missed appointment.

*If you are a new patient and do not keep your scheduled appointment and did not call prior to the appointment to cancel or reschedule, you are considered a no show. We will reschedule the appointment for you, but if you do not keep the next appointment, you will not be able to reschedule again.

 


Prescription Refills

*All new prescriptions require an office visit. For medicine refills, please have your pharmacy fax over a request.

*Refill requests will be completed within 24 hours of the request with the exception of weekends and holiday hours.

*If you are using a mail order for refill of medications, please provide the nurse with your mail order prescription form.

 


Payment Policy

We are pleased that you have chosen our practice for your medical services. This policy is intended to briefly explain our billing and payment options.

 

Billing for Services

Our registration staff will ask you to verify your insurance, address and email information at each of your office visits.

For most insurance companies, we will submit bills directly to your insurance company for payment. You will be notified if we are unable to submit bills to your insurance company. In this case, you will be supplied with all billing information required for you to submit your own claim and payment in full will be requested from you at the time of service.

Any questions regarding your billing, please contact our billing service agent at our toll free number:  (855) 206-9963.

 



Collection of Co-Payments and Payment of your Bill

Payment of all known deductibles, co-payments, co-insurance (percentage plans) and non-covered services will be requested at the time service is rendered.

Patients without insurance will be asked for payment in full when service is provided.

If you are unable to make payment of any required co-payment, your appointment will be rescheduled.

Regardless of the type of insurance coverage, patients are ultimately responsible for payment of their medical bills.

 



Payment Options for Our Valued Patients

We accept cash, checks, credit or debit cards (Visa, Mastercard and American Express) as a convenience to our patients.

There is a $25.00 return check fee for all checks return for insufficient funds.

 



Past Due Balances

We ask that all previously unpaid balances be pain prior to your next visit. If you are unable to make payment to clear past due balances, your appointment may be rescheduled.


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