Financial Policy and AOB

1. Insurance: Your insurance policy is a contract between you and your insurance company. It is your responsibility to understand your benefits including information pertaining to co-payments, co-insurance and deductibles. As a courtesy, Diamond Lake Clinic will file claims for benefits with your insurance company. In order to properly bill your insurance company, it is important that you provide all insurance information including primary, secondary and tertiary insurance, as well as, notify Diamond Lake Clinic of any changes to your insurance information. Failure to provide this information may results in larger or inaccurate amounts of patient responsibility.

If your insurance company is not contracted with Diamond Lake Clinic, the clinic is considered out-of-network for your visit. If you decide to obtain care with an out-of-network provider, you will be responsible to pay any portion of the charges not covered by your insurance, including those charges above the usual and customary allowance.

If claims are denied, full payment will become the patient’s responsibility.

2. Copayments & Deductibles: All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud.

3. Non-covered services: Please be aware that some – and perhaps all – of the services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for all non-covered services; it is your responsibility to verify with your insurance that services are covered.

4. Proof of Insurance: All patients must complete our patient information (Intake) form before seeing any Diamond Lake Clinic provider. We must obtain a copy of your valid government photo-ID and current valid insurance. If you fail to provide us with the correct insurance information, you will be responsible for the balance of the claim.

5. Outstanding Balances: Any outstanding balances should be paid at the time of service unless prior arrangements have been made. If your insurance does not pay the balance in full, you will receive a statement. Payment is due upon receipt of your statement. Failure to pay your balance may result in your appointments being cancelled and your account being transferred to an outside collection agency. If your account is turned over to an outside collection agency, all balances must be paid in full prior to initiating additional treatment for a new problem. If your account is placed with a collection agency, you may be dismissed as a patient from Diamond Lake Clinic.

6. Coverage Changes: If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum insurance benefits.

7. Balances: A balance is considered “overdue” when the patient has not made a payment on the amount due within 1 billing cycle (30 days). Patients with balances exceeding $200.00 or with an overdue balance of 90+ days will be required to comply with one of the options below:

(i) Pay off their balance

(ii) Set up a payment plan with a credit card on file

(iii) Pay upfront for their appointment before being seen by a provider

(iv) Reschedule the appointment until their balance is reduced to under $200.00

Diamond Lake Clinic is committed to providing the best treatment to all of our patients. Our prices are representative of the usual and customary charges for our area. Please call the clinic to discuss a partial payment plan if you are unable to pay your balance in full. If you do not make a payment plan, Diamond Lake Clinic will charge the full amount accrued to your credit card.