We provide the following financial policy to avoid any misunderstanding. If you have any questions regarding this policy, please discuss it with our staff prior to your appointment. We are dedicated to providing the best possible care and service. We consider your understanding of these financial responsibilities to be an essential part of our professional relationship. Thank you.
Insurance Information and Billing Policies
To provide the best care and to ensure the availability of services, please call as soon as possible to reschedule or cancel your appointment.
The $25 Scheduling Deposit is applied towards your consultation appointment. Refundable until 3 calendar days prior to appointment date. Not refundable thereafter for cancelation or postponement.
The $100 Scheduling Deposit is applied towards your procedure appointment. Refundable until 7 calendar days prior to appointment date. Not refundable thereafter for cancelation or postponement.
If your insurance company requires prior authorizations for medications or diagnostic imaging tests the facility that is performing the service will do the authorization. Our office will help assist the other facilities but if we have to complete the entire prior-authorization service, if requested by the patient, the fee is $50.00 per authorization. We will complete prior authorizations for office visits, office procedures, and outpatient surgeries at no charge.
If your insurance company determines that a service or supply is “not covered,” you will be financially responsible for that particular service or supply.
There is a fee of $25.00 to process disability forms, life insurance policy application forms, FMLA, and other related forms (up to 3 pages, with $5 per each additional page).
There is a fee of $15.00 for copying/preparing medical records. Records cannot be emailed.
There will be a $40.00 charge for each insufficient-fund check you issue.
If you receive a statement from our office, payment is due 30 days from the date of the statement. A finance charge of 18% APR will be assessed to past-due accounts from the date of the statement. Any past-due accounts may be sent to a third-party collector or attorney. For past due accounts, you agree to pay a collection fee in the amount of 40% of the past-due amount, if sent to a third-party collector or attorney, and any costs and reasonable attorney’s fees incurred in collecting the past-due amounts under your account.
Please contact your insurance company to ensure that Utah Urology is a “participating/preferred/in-network provider” on your plan before scheduling an appointment. Note that some plans may require you to obtain a “referral” from your primary care provider before seeing a specialist. We can still provide medical services even if we are not on your “preferred provider” list. Your insurance coverage will be determined by any “out of network” benefits you may have as dictated by your plan. It is recommended that patients contact their insurance carriers to verify benefits and eligibility for services to be provided by Utah Urology.
As a courtesy to you, we verify insurance benefits and eligibility before your visit. Using your personal insurance benefits information, we will calculate an estimate of your patient responsibility. Any applicable copayment, coinsurance, and unmet deductible will be collected at the time of service. If payment is not arranged, we may ask you to reschedule your appointment.
If Utah Urology is “in-network” with your insurance plan, then the “price” of your visit is determined by your insurance company, not by Utah Urology. As an in-network provider, we are contracted with your insurance company to offer the in-network or discounted rate. If you are unsure about the costs associated with visiting a specialist or your coverage, please contact your insurance company. Note that insurance companies are responsible to you, the policyholder, not to the physician.
We have made prior arrangements with many health plans to accept an “assignment of benefits”. This means that for most plans we can bill your insurance company directly. As a courtesy, our billing department may also attempt to appeal denied claims on your behalf.
If you have a health plan with which we do not have a prior agreement, you will be seen on an “unassigned” basis. If this applies to you, we will collect payment directly from you and is due at the time of service and you will be responsible for requesting reimbursement from your insurance company by submitting your claim.
Fees for services and/or supplies not covered or paid by your insurance are to be paid directly by you and collected at the time of your visit or will be billed once it is determined the services are not covered or paid by your insurance.
Fees for services and/or supplies that are not billable to insurance carriers are to be paid directly by you and collected at the time of your visit.
Patients who do not have insurance coverage or who fail to provide us with their health plan information will be required to pay in full at every visit.
We do not determine your coverage. Your insurance company ultimately determines your coverage and you should be aware of your benefits before office visits and procedures. Any questions you may have concerning your insurance benefits should be directed to your insurance plan representative.