St Clare Medical Building on St Mary Medical Center Campus Langhorne PA 215-750-7771
Financial Responsibility Policy
Welcome to Women’s Specialists of Bucks County, PC. Thank you for choosing our office for your healthcare needs. We are committed to providing you the very best we have to offer and building a successful physician-patient relationship with you. Your clear understanding of our Patient Financial Policy is important to our professional relationship. Please understand that payment for services is a part of that relationship. Please ask if you have any questions about our fees, our policies, or your responsibilities. It is your responsibility to notify our office of any patient information changes (i.e. address, phone number, name, insurance information, etc).
The patient is expected to present an insurance card at each visit. All co-payments and past due balances are due at time of check-in unless previous arrangements have been made with a billing team member. We accept cash, money orders, checks or credit cards. Absolutely no post-dated checks will be accepted.
Insurance is a contract between you and your insurance company. In most cases, we are NOT a party of this contract. We will bill your primary insurance company as a courtesy to you. In order to properly bill your insurance company we require that you disclose all insurance information including primary and secondary insurance, as well as, any change of insurance information. Failure to provide complete insurance information may result in patient responsibility for the entire bill. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits. If your insurance company is not contracted with us, you agree to pay any portion of the charges not covered by insurance, including but not limited to those charges above the usual and customary allowance. If we are out of network for your insurance company and your insurance pays you directly, you are responsible for payment and agree to forward the payment to us immediately.
Self-pay accounts are patients without insurance coverage, patients covered by insurance plans in which the office does not participate, or patients without an insurance card on file with us or proof of insurance. It is always the patient’s responsibility to know if our office is participating with their plan. If there is a discrepancy with our information, the patient will be considered self-pay unless otherwise proven. Self-pay patients will be required to pay at the time of the appointment. Extended payment arrangements are available if needed. Please ask to speak with a billing team member to discuss a mutually agreeable payment plan. It is never our intention to cause hardship to our patients, only to provide them with the best care possible and the least amount of stress.
Missed Appointments/No Show
Women’s Specialists of Bucks County requires 24-hour notice of appointment cancellation. Appointments missed and are not previously cancelled will be charged a fee of $75.00. This fee is the sole responsibility of the patient and must be paid in full before the patient’s next appointment. Repeat missed appointments may result in patient discharge from the practice.
Disability, Insurance Forms, Attending Physician Statements, FMLA Forms There will be a charge of $20.00 for the completion of medical forms or you may be required to schedule an appointment. Payment is due at the time that you drop-off or pick-up these forms. Please allow 7-10 days for the completion of these forms. If you would like the forms mailed, completed online or faxed to you or the insurance, payment will be due prior to mailing, online completion or faxing.
The charge for Medical records varies based on the size of the chart. This is a government based fee under Under 42 Pa. C.S. § 6152.1. A signed compliant Medical Records Release will be required with payment prior to the release of any records. Patients who have a past due account will also be required to satisfy their balance prior to the release of records.
The charge for a returned check is $35 payable by cash, money order, or credit card. This will be applied to your account in addition to the insufficient funds amount. You will be placed on a cash, money order or credit card only payment basis following any returned check.
If you are having surgery, we will check your benefits and you will be required to pay any self-pay or patient responsibility amounts prior to your surgery date.
Past Due Accounts/Collections
Patients who have a past due account will be required to satisfy their outstanding balance prior to scheduling appointments. If we refer your account to a collection agency, you must pay all past due amounts or make agreeable payment arrangements before you can schedule further appointments with our practice. Accounts that are not paid within 30 days begin our in house collection process. If your balance becomes 65 days old, your doctor will be notified and you may be subject to dismissal from the practice.
If you have any questions or concerns regarding this financial responsibility policy please contact one of our billing team members at 215-750-7771.
I acknowledge that I have received and read a copy of Women’s Specialists of Bucks County, P.C. Financial Policy.
1203 Langhorne-Newtown Rd
St. Clare Medical Building, Suite #225
Langhorne, PA 19047
Call Us: 215-750-7771
Monday: 9:00am to 8:00pm
Tuesday: 7:30am to 4:00pm
Wednesday: 7:00am to 7:30pm
Thursday: 8:00am to 7:00pm
Friday: 9:00am to 4:00pm
Phones available Monday through Friday from 8am to 4pm.
All other calls will be taken by our live operator answering service.
For medical emergency, call 911 immediately.