FAMILY HEALTH CARE CENTER
FINANCIAL POLICY
Due to the new complexities of the health care law, we want our patients to know our financial policies ahead of
their office visit.
Please read this carefully and call our office at 248 543-2000 if you have any questions or concerns.
1. On arrival, please sign in at the front desk and present your current insurance card and driver’s
license at every visit. This allows us to verify that you have the insurance that we participate with.
2. According to your insurance plan, you are responsible for all knowledge regarding your benefits
and payments for any and all co-payments, deductibles, coinsurances, prior authorization and
specialist referral policies, Please familiarize yourself regarding these issues ahead of your visit. We
presently do not participate with Medicaid, insurance exchanges, Blue Care Network or any HMO’s
except Priority Health and HAP , both on a limited basis so if you have this insurance, please call us first
to be sure we are still taking new patients.
3. If our physicians do not participate in your insurance plan, payment in full is expected from you
at the end of your office visit. Please make sure you are aware of your physician’s participation before
you see him/her.
4. Prior patient balances over 60 days old must be paid in full prior to any further office visits.
5. We are happy to try to make payment arrangements at any time and continue to see you if you have
medical issues, however if you renege on this agreement, you may be discharged from the practice.
6. If you do not have insurance, payment for an office visit is to be paid in full at the time of visit.
7. You are responsible to know what your Copayments are so please find this out before coming to the
office for your visit. They are due at time of service.
8. Cancellations-We will attempt to phone in an auto-reminder no less than 48 hours ahead of your
appointment. We require 24-hour notice for cancellation of any appointments. If you need to cancel
an appointment due to extenuating circumstances within a 24 hour window and it is after office hours,
please leave a voice mail with our medical director, Dr. Paul Ehrmann at 248-563-0386. For repeated
cancellations within the 24 hour window, there may be a charge made of $25.00 dollars against your
account for repeated activities.
9. No Shows-We take this action very seriously since that office visit spot could have been used for a
patient that was sick that needed to come in that day. Accordingly, we have developed the following
policy regarding no show appointments (did not show, no phone call ahead of time):
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If you miss an appointment that is not a complete physical or surgical procedure, you will be assessed a
$25.00 charge against your account which will need to be paid before your next office visit
If you miss a second time, you will be notified and assessed a $50.00 charge that is payable before your
next office visit.
If you miss a third visit, you will be discharged from the practice.
If you miss a complete physical examination (cpe) or surgical procedure (sp) for the first time in the
above manner, you will be assessed $100.00 in the same manner that is payable in full ahead of any
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rescheduling. We will not be able to reschedule you for at least one month from the day of the missed or
no show appointment
If you miss another one then you will be discharged from the practice
10. Form –Records and Miscellaneous Charges:
We follow the following guidelines and timelines:
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FMLA, Disability or Life Insurance=$25-50 dollars depending on complexity to be determined
by our medical director. Payment is due at the time your drop off your form. Allow 3-7 business
days for completion.
Record Releases from Insurance Companies or Self-We follow the suggested payment schedule
as outlined by the Michigan State Medical Society. Payment is due at the time of the request
once total page determined. We will notify you or your insurance company once determined.
Allow 14 business days for completion from the point that payment is received for pick up, U.S.
mail or secure fax send.
-$1.00 per page for the first 20 pages
-50 cents for every page 21-50
-20 cents for every page 51 forward
$35.00 for Non-Sufficient Fund check
11. Advance notice is needed for all non-emergent specialty or imaging test referrals, typically 3 to 5
business days. It is your responsibility to know if a selected specialist participates in your plan.
Remember your primary care physician may need to approve referrals before you go to a specialist.
12. Before making an annual physical appointment, please check with your insurance company
whether the visit will be covered as a healthy visit or a symptom visit. Not all plans cover annual
healthy physicals or hearing and vision screenings. It is your responsibility to know your insurance
plans benefits. If it is not covered, you will be responsible for payment at the time of visit. Please
communicate to our medical assistants at the time of intake in the exam room if you are receiving a
preventative exam or a symptom exam. Testing may proceed accordingly.
13. Not all services provided by our office are covered by every plan. Any service determined to not
be covered by your plan will be your financial responsibility.
14. You may pay your bill at any time either in person, by mail or phone by credit card. We take Visa,
Master Charge, Discover and American Express. We may have a secure online option to pay your bills
soon
11/1/2015