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
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
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
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.