John C. Lincoln Physician Network Financial Policy

Financial Policy Form

Download our Financial Policy form, which you can sign and return to your physician's office. (PDF)

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We are dedicated to providing the best possible care and service to you and your family. Your complete understanding of your financial responsibilities is an essential element of care and treatment.

Non-Covered Services: It is the patient's responsibility to know their insurance coverage benefits and present their card at each visit. We ask that you contact your insurance carrier to review your benefits prior to being seen. You will need to verify coverage for all preventive care such as physicals, routine immunizations, employment screening, Department of Transportation physicals, radiology services and labs. There are numerous insurance plans and we cannot be responsible for ordering services that you are requesting that may or may not be a covered benefit on your plan.

Change in Insurance Plans: You are expected to notify our office if your insurance coverage changes. We ask you to update your record at each visit to our office. It is your responsibility to notify the office immediately of these changes. Balances left over 90 days will become the responsibility of the patient. Insurance carriers give us a 90 day period to submit claims to them for payment. After that time it will be denied as past timely filing. If we are unable to process your claim due to incorrect information given we will have no other choice but to bill you directly for our services.

Payment is required at the time of service: Patients who are not covered by health insurance, on a plan that we do not participate with, or if we are not able to verify your coverage must pay at the time of service. Any unpaid or denied claim over 90 days old becomes the responsibility of the patient. Patients who have plans that we do participate with are asked to pay their co-payment, co-insurance, deductibles, or any non-covered services at the time of their visit. We charge a $25.00 fee for any returned checks over and above what your financial institution may charge.

Collection Agency Fees: Should your account become severely delinquent, the patient or guarantor agrees to pay all costs of collection including attorney fees, collection fees and contingent fees to collection agencies of not less than 35%. The Contingency fees will be added and collected by the collection agency immediately upon our referral of your account to the collection agency of our choice.

Motor Vehicle Accidents: We do not bill for any motor vehicle accidents regardless of fault. You must pay in full at the time of service. You will be supplied with the necessary forms to turn in to the insurance carrier.

Missed Appointments: New patients must arrive at least 20 minutes prior to their scheduled appointment to fill out the necessary paperwork and verify eligibility with your insurance carrier. Established patients are asked to arrive at least 15 minutes prior to their appointment. Multiple missed/no show appointments may result in being charged a $25 no show fee, as well as discharge.

Minors: For all services rendered to minor patients, the parent or guardian who brought the patient to the appointment, is responsible for payment.