Policies and terms for Reconstructive & Aesthetic Surgeons, Inc. in Toledo.
Thank you for choosing Reconstructive & Aesthetic Surgeons, Inc. for your healthcare needs. We are committed to building a successful physician-patient relationship with you and your family. Your clear understanding of our Patient Financial Policy is important to our professional relationship. Please understand that payment for services is part of that relationship. If you have any questions about our fees, our policies or your responsibilities, please don’t hesitate to ask. Also, it is your responsibility to notify our office of any patient information changes (i.e. address, name, insurance information and medical history).
CONSULTATION FEES —
When scheduling a Cosmetic Consultation we require a $75.00 non-refundable down payment by Credit Card in order to reserve your appointment time. We kindly request at least 24 hours’ notice in the event you need to cancel or reschedule. Failure to do this 24 hours in advance, or no show to your appointment, will forfeit your down payment.
Insurance is a contract between you and your insurance company. Co-pays are determined by your individual Plan and are due at the time of service. It is the patient’s responsibility to know what is, and is not covered under their individual policy. We will file claims to both your primary and secondary insurance companies as a courtesy to you. In order to properly bill your medical claims we require that you provide our office with accurate insurance information. In the event insurance does not reimburse the provider, the balance is the patient’s full responsibility. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits. If your insurance company requires a referral and/or prior-authorization, it is the patient’s responsibility to obtain one.
Patients paying out of pocket for office services are required to pay the day of their visit. All fees for Cosmetic Procedures are due in full two weeks prior to surgery. A deposit of $1,000 is required to schedule surgery and to reserve operating room time.
We are more than willing to work with patients on payment arrangements when possible. If your account is more than 60 days overdue, you will be required to pay at each visit until the delinquent amount is paid in full (this is referred to as “cash basis” terms). If no resolution can be made between the patient and the practice, a final letter will be sent and the account will be turned over to the Collection Agency. In the event that an account is turned over to the Collection Agency, the account is no longer handled in our office. The person financially responsible for the account will also be responsible for all further collection fees incurred thereafter, including but not limited to filing fees, attorney fees and court costs.
A $35.00 charge will be billed to the patient for any returned check.
MEDICAL RECORDS REQUESTS/FEES—
A Release of Information form must be signed when you request someone to have access to your medical records (ie: physicians, lawyers, family members). This is for your own protection. Please allow 7-10 days for requests to be processed. Fees will be accessed for copies of Medical Records. We follow ODH standards for record copying fees.
In the case of a Workers’ compensation injury, you must obtain the claim number, phone number, contact person, and name and address of the insurance carrier prior to your visit. If this information is not provided, you will be asked to either reschedule your appointment or pay for your visit at the time of service.
We are not accepting new patients who are covered by benefits from the Ohio Department of Jobs & Family Service. We will provide treatment to our current patients who receive these benefits. Payment at the time of service is not required; however, these patients are responsible for the payment of any non-covered services they request and/or receive.
We are happy to provide treatment to patients involved in accidents; however we are not equipped to become involved in litigation. Payment is expected at the time service is rendered.
DIVORCED PARENTS OF MINORS—
The responsibility for payment of services rendered to minor children who are divorced rests with the parent who is seeking treatment and signing off on office documents. Any court-ordered responsibility judgment must be determined between the individuals involved, without the inclusion of our office. Our office will not send bills or records to the other guardian for issues of payment or communication. Parents are responsible to communicate with each other about the treatment and payment issues regarding the minor.
Please print and fill out the following forms before your appointment.