Your visit and follow-up care may be completed using internet-based technologies commonly referred to as Telemedicine. Telemedicine services involve the use of secure interactive videoconferencing equipment and devices that enable health care providers to deliver health care services to patients while the provider and patient are in different locations.
Payment Expected at Time of Service: You must pay any co-payment or deductible at the time of service prior to your appointment date. The insurance portion of your bill will be sent to your insurance company for direct payment to our practice. Any changes or accommodations for this policy must be agreed to in advance.
If your insurance company remits this payment to you, please send it to us along with all paperwork sent to you at that time. Please do not send it back to the insurance company, for this will only delay financial payment that you will be required to pay to our office.
Filing Your Insurance Claim: NCD will file a claim on your behalf with your insurance company. Under the provisions of plans with some companies, your insurance may refuse payment of a claim if:
If your insurance company denies the claim for any reason, our practice will not be responsible for this bill. It is the responsibility of the patient to pay the full amount. Remember, that as a consumer of healthcare services, you are ultimately responsible for payment of your medical expenses. If your account is not settled within 45 days of the date of service, we reserve the right to collect payment from you. If payment is not received within 90 days, we reserve the right to turn your account over to collections and discontinue providing services.
Portal and Phone Messages: We understand that there are times when you or your family may have questions related to your care. The best way to communicate with your care team at NCD is to send a portal message. If you leave a voice message, it may take a little bit longer to get back to you. It may be necessary for us to manage some of your care through portal messages and phone calls. These encounters are billed to your insurance company. In addition, the federal government requires the use of portal messaging to maintain our reimbursement levels.
Last paragraph – By agreeing to these terms of service, I attest that I (1) have personally read this form (or had it explained to me) and fully understand and agree to its contents; (2) have had my questions answered to my satisfaction, and the risks, benefits, and alternatives to telemedicine visits shared with me in a language I understand. By agreeing to these terms of service, I attest that I (1) have personally read this form (or had it explained to me) and fully understand and agree to its contents; (2) have had my questions answered to my satisfaction, and the risks, benefits, and alternatives to telemedicine visits shared with me in a language I understand.