At the Illinois Institute of Gynecology and Advanced Pelvic Surgery, we want you to be fully informed about our services and fees. We are in network with most insurances. Please call our office for more information. We accept most credit cards, checks and money orders. We also accept payments by phone or through the portal. For more information about our services and fees, please contact our Billing Department at 630-635-0441 or email at email@example.com.
Thank you for coming to the Illinois Institute of Gynecology and Advanced Pelvic surgery, SC. We believe that good care for you and your family starts with good communication, and we have created this policy to help our patients understand the responsibilities that they and their families have for payment of our fees. If at any time you have questions or problems with our fees or payment process, please don’t hesitate to talk to Maureen at 630-635-0441 or email firstname.lastname@example.org (RE: Billing Question).
We require that our patients promptly pay all charges that we present to them. In some cases, our fees may be adjusted, based on whether we participate in or accept insurance or government program payments, allowances, or limitations. But, if we present a charge to you, it means that we have taken any such adjustment into account and that you must still pay the amount remaining. If you are reimbursed directly by your health insurance for the cost of your care, you must still pay our charges promptly, whether or not you have received that reimbursement.
If you do not agree with patient responsibility amounts or reimbursement amounts set by your insurance or government program, this is a matter between you and that program. We are happy to provide you with factual information about your care and billing to help you discuss this with them, but we still require you to promptly pay the entire charge we present to you, even if your issue with the program is not resolved.
Payment for our services is due at the time that those services are provided to you. In order to make it easier for our patients, we accept Cash, Visa, Mastercard, Discover, Credit Card Payment by Phone, Checks and Echecks. We expect that all charges we present to you at a visit will be paid at the time of the visit. This includes, among other things, copay amounts, program deductibles, earlier charges that remain unpaid, and charges for services that we believe are not covered by, or are left over as your responsibility to pay after coverage by, insurance or government programs. We may also present charges to you by written statement via the mail following a visit. If we do this, we expect that each charge will be paid in full by return mail the first time it is presented to you. We or our agents may send you statements and reminders of charges made and amounts that we believe must be paid, or may call you about the same. By accepting our services, you are consenting to receive these communications.
If you have a past-due balance on your account, you may be reminded of this when calling to make an appointment and will be asked to bring this payment with you to your next appointment. Past due accounts greater than 90 days are subject to third party action and potential discharge from the practice. Accounts sent for collection action will be assessed a $30 collection charge. If you need special payment arrangements, please contact Maureen at 630-635-0441. We are able to provide short-term payment plans for emergency situations. 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 only be able to treat you on an emergency basis.
We have a $35 returned check charge for any checks returned to us by your financial institution as non-paid. In addition, a $25 billing charge will also be added to your account for any statements sent as a result of a returned check. Stop payments constitute a breach of payment and are subject to the $30 service fee and collections action. All bad checks written to this office are subject to collections.
A patient who arrives more than 15 minutes after his/her appointment is considered a late arrival. A late arrival, not considered to be the responsibility of the Practice, will be registered and worked into the schedule as soon as possible. If the patient is more than 30 minutes late, the appointment may be rescheduled. If you are unable to keep an appointment, we request that you contact us as soon as possible so that we are able to offer that appointment time to another patient. Multiple no-shows will result in discharge from the practice.
Cancellation and No Show Policy
We understand that there are times you are unable to make a scheduled appointment. If you need to cancel or reschedule an appointment, please notify us with at least two business days’ notice. For example, a Monday appointment should be canceled by Thursday(the week before); an appointment for Wednesday should be canceled by Monday. Otherwise, a late cancellation/no-show fee of $35 will apply.
Card on file and Automatic Payment Plans
How will I know when my card is being charged?It is our Policy to store your credit card on file. You will be asked to sign the Card on File Agreement on the day of your visit. With Card on File, we can collect outstanding balances automatically as soon as the insurance company processes your claims. Credit card numbers are encrypted and stored securely by Elavon, a leader in the credit card industry and an affiliate of U.S. Bank. (No credit card numbers are stored in our practice.) With Card on file you can:
Pay future balances and copays conveniently Make payments automatically using their credit card of choice
Avoid writing checks to pay monthly bills by mail Specify a total maximum amount to be charged
Cancel the contract at any time
Receive notifications and receipts sent via email It is your responsibility to pay your balance in full upon receipt of Billing Statement. However, when it is not possible to pay the balance in full due to a large balance, you may sign a Payment Plan Agreement.