New patients and established patients with any changes to your insurance or demographics need to check-in 15 minutes prior to your appointment time to allow the receptionist enough time to process your information.
APPOINTMENT NO SHOW POLICY
In order to provide the best care and service to our patients, we ask that you notify us at least one day prior to canceling or rescheduling your appointment. Patients who fail to appear for their appointment without notifying the office may be subject to a $25.00 No-Show charge. This fee will be charged directly to the patient and not to the patient’s insurance. Patients who fail to show for their appointment more than 3 times may also be subject to dismissal from the clinic. Patients may contact the Office Manager at (509) 334-5876 to request a waiver if there is an extenuating circumstance.
LATE FOR APPOINTMENT POLICY
If the patient is not available at the scheduled time, the appointment time may be given to the next scheduled patient. The originally scheduled patient can either reschedule or wait for the next available appointment time, which may or may not become available that day. Patients who are late for their appointments more than 3 times will not be allowed to schedule without prior approval from the attending physician, and may also be subject to dismissal from the clinic.
PATIENT FINANCIAL AGREEMENT & RELEASE OF INFORMATION
During your visit:
- Copays are due at time of check-in as outlined in the provisions of your insurance policy.
- Account balances are due upon check-in/check-out. In the event this is not possible, you will need to set up a payment plan with our Central Billing Office by calling (509) 332-6139.
- For out of network plans or high deductibles you may be asked for a deposit towards treatment or pay your insurance’s allowable rate at the time of service.
- All insurance plans have exclusions to their policy. We advise you to review your insurance plan’s exclusions prior to your visit.
Private Pay/ No Insurance:
- Payment is due at the time of service.
- Most services are eligible for a 20% discount for payment in full at the time of service. Please contact our central billing department at (509) 332-6139 with any questions.
When you complete the New Patient Registration form you will be asked to sign and date these policies:
“I understand that payment is due within 15 days of the monthly billing date. Failure to pay on my account may result in placement to a collection agency and I agree to pay a collection fee of $25.00 in addition to any balance due. I certify that the above information is correct to the best of my knowledge. I will not hold my doctor or any members of the staff responsible for any errors or omissions that I may have made in the completion of this form. I understand that I am financially responsible for all charges whether or not paid by my insurance company. I, the undersigned, authorize treatment and request payment of authorized Medicare and/or other insurance benefits be made payable on my behalf to Pullman Regional Hospital Clinic Network, LLC, for any services furnished to me or my dependents by Pullman Regional Hospital Clinic Network, LLC or its affiliates. I authorize the holder of medical information about my dependents or me to release to the Centers for Medicare & Medicaid Services (CMS), its agents, and/or my current insurance company or any subsequent insurance companies from which I obtain coverage, any information needed to determine these benefits or the benefits payable for related services. If “other health insurance” is indicated, or elsewhere on other approved claim forms or electronically submitted claims, my signature authorizes releasing of the information to the insurer or agency shown.”