“InstaMed makes paying my bill as easy as Amazon or Uber! Now, I don’t have to worry about my bill. I’m so glad PREventClinic provides this.” -Bobbie T.
IMPORTANT: SIGN THIS FORM ONLY AFTER READING AND UNDERSTANDING ITS CONTENTS. Please read these policies carefully and sign below, indicating that you have read and understood the policies detailed within.
The billing policy of PREventClinic, Inc. has been instated to facilitate and simplify billing and the bill payment process. We have partnered with InstaMed, the leading healthcare payments network, to securely save your credit/debit card, HSA card or bank draft on file. Your balance will be applied against your form of payment after your insurance benefits are fully applied. This will occur 48 hours after receipt of Explanation of Benefits (EOB) from your insurer.
It is the policy of PREventClinic, Inc. that payment is due at the time of service. All patients must pay their deductible, copay and/or coinsurance payment at the beginning of each visit. At the conclusion of your visits with us, you will be billed for any outstanding balances. If there is a credit after adjudication of your bill, you will be provided a refund promptly.
As a courtesy, PREventClinic verifies your benefits with your insurance company. A quote of benefits is not a guarantee of benefits or payment. We highly recommend you also contact your insurance carrier and check into your coverage for (cardiology/cardiovascular services). Do not assume that you will not owe anything if you have more than one insurance policy.
We do all the work for you. This billing policy eliminates the hassle of writing and mailing paper checks. It also eliminates the chance of your personal information being viewed or stolen.
Although we are contracted with most insurance carriers, our services may not be covered by your particular insurance plan. Being referred to our clinic by another physician does not necessarily guarantee that your insurance will cover our services. Please remember that you are 100 percent responsible for all charges incurred: your physician’s referral and our verification of your insurance benefits are not a guarantee of payment.
No-Show Policy (Updated March 2022):
This fee is the responsibility of the patient and cannot be filed with insurance companies. We are happy to reschedule your appointments, provided changes to your appointment are made with our office during regular business hours. Any late cancellations made with after-hours answering service will still incur the charge.
I have read the policies listed above. I hereby authorize payment directly to PREventClinic, Inc that are otherwise payable to me for services as described. I realize that I am required to pay for non‐covered services.________________________________________________________ _________________