Cash Patient Policy Agreement
GENERAL FEE SCHEDULE: |
PAYMENT DUE: |
| OFFICE VISITS |
MUST BE PAID IN FULL AT END OF VISIT |
(*this includes all physician consultation fees, radiographs, therapeutic modalities/treatments, and any durable medical equipment, such as splints, etc.) |
| DURABLE MEDICAL EQUIPMENT, ETC. |
MUST BE PAID IN FULL WHEN DISPENSED |
(*this includes any replacement or additional splints, etc., required for specified treatment by Dr. Ross Nathan, and/or when requested by the patient) |
| IN-OFFICE PROCEDURES |
MUST BE PAID IN FULL AT END OF VISIT |
(*this service is NOT included in routine medical visit fees – this is considered a minor "in-office" procedure and will be billed accordingly) |
| SURGERY |
MUST BE PAID IN FULL BY THE PRE-OP |
(*Note: The surgery fee is quoted at a discounted price. Depending on the actual procedure performed at surgery, the surgery fee may require future adjustments. Fee increases will be billed to the patient, and decreases will be refunded once the account has been adjusted) |
| THERAPY VISITS |
MUST BE PAID IN FULL AT END OF VISIT |
(*this fee represents the basic therapist fee, and DOES NOT include fees for specific modalities, etc. associated with treatment) |
| THERAPY MODALITIES/DURABLE MEDICAL EQUIPMENT |
MUST BE PAID IN FULL AT END OF VISIT |
(*this includes all specified treatment(s) rendered by the therapist, as well as any splints, braces, and/or other materials provided by the therapist in regards to the medical condition being treated) |
CASH patients will be held completely responsible for all accrued charges and account balances regarding all services rendered by The Hand & Wrist Center. There are two options for payment: "Cash" (cash or personal check) or Credit Card (Visa, MasterCard or American Express*) under the "CASH" Policy agreement.
* American Express only acceptable by Dr. Nathan.
« Back to Financial Policy | Download Forms for Cash Patients
|
