Payment Policy

Thank you for choosing PriMed Healthcare/Dr. Rafael Jimenez' office as your Cardiovascular healthcare provider. We are committed to providing you quality healthcare. Because some of our patients have had questions regarding patient and insurance responsibility for services rendered,we have decided to develop and put in place a payment policy. Please read it, ask us any questions you may have, and sign
in the space provided. A copy will be provided to you upon request.

1. INSURANCE : We participate in most insurance plans,including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit and/or at the time services are rendered. If you are insured by a plan we do business with but do not have an up­ to-date insurance card, payment in full for each visit or service rendered is required until we can verify your coverage. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have.

2. PROOF OF INSURANCE: All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your driver's license and current valid insurance to provide proof of insurance . If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.

3. CO-PAYMENTS AND DEDUCTIBLES: All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payment and deductibles from patients can be considered fraud. Please help in upholding the law by paying your co-payment at each visit or at the time service is rendered. For your convenience we accept cash, MasterCard, VISA, and Discover.

4. CLAIM SUBMISSION: We will submit your claims and assist in any way we reasonably can to help get your claims paid. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the allowable amount from your insurance company will be billed to you, the member, if you do not comply
with their request and this balance will be your responsibility. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.

5. COVERAGE CHANGES: If your insurance changes, please notify us before your next visit or service rendered so we can make the appropriate changes to help you receive your maximum benefits. Failure to provide us with any insurance change prior to or at the time of your visit will result in the allowable amount for services rendered billed to you the member and it will be your responsibility .

6. PAYMENT PLAN: Please let us know if you are having difficulty paying your account. We may be able to help you be sett ing up a payment plan based on your hardship. In this case,you will be asked to sign a promissory note. You are responsible to honor and keep the promissory note payments current.

7. NONPAYMENT: If your account is over 90 days past due and you failed to comply with any promissory note arrangements, you will receive a letter stating that you have 30 days to pay your account in full. Partial payments will not be accepted unless otherwise negotiated. Please be aware that if a balance remains unpaid, we will refer your account to a collection agency and you and your immediate family members may be discharged from this practice. If this is to occur you will be notified by regular and certified mail that you have 30 days to find alternative medical care. During that 30-day period,our physician will be available to treat you in case of an emergency.

8. MISSED APPOINTMENTS: Our policy is to charge for missed appointments not canceled within 24 hours. These charges will be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment or canceling with enough time to serve another patient's need.

Our practice is committed to providing the best treatment for our patients. Thank you for understanding our payment policy. Please let us know if you have any questions or concerns.