Patient Financial Policy & Responsibility

Thank you for choosing Elizabeth Wende Breast Care, LLC. as your health care provider. Our goal is to build a successful physician-patient relationship with you. Your understanding of our patient financial policy and your responsibility for payment of services is important to our professional relationship. It is your responsibility to notify our office of any changes in your address, name, telephone, insurance information, etc.

If you have any questions about our fees, our policies, or your responsibilities, our billing department is available at 585-442-1830 and happy to assist. 

Payment

Insurance Claims 

Self-pay Accounts

Missed Appointments

Outstanding Balances 

 

Payment

Payment is expected at time of visit whether you have a copay or deductible plan. Please be aware if you are scheduled for a screening mammogram and additional testing is recommended, the additional tests are diagnostic and may result in out-of-pocket expenses from you due to deductibles, co-insurance and/or co-pays. Every insurance policy is different – please consult with your insurance company to determine if your diagnostic tests will be covered. 

•    There will be an additional $20 charge for co-payments and deductibles not received at time of service.  

Insurance Claims 

We will bill your insurance company for services received by you at our office. To properly bill your insurance company, we require that you provide all insurance information including primary and secondary insurance, as well as any change of insurance information.

•    You are expected to present an insurance card at each visit. Copayments and past due balances are due at time of check-in unless previous arrangements have been made with our billing department. You may pay by cash, check, money orders, or credit cards.

•    Payment for known copays, co-insurance, and deductibles are your responsibility, and will be due at the time services are performed. It is the insurance company that makes the final determination of your eligibility and benefits. If your insurance company is not contracted with us, ie, if the practice is not part of your insurance’s network, you agree to pay all charges that are not covered by insurance.

•    Not all services provided by this office are covered by every plan. You are responsible for understanding your benefit plan and for knowing its requirements for referrals to specialists, preauthorization of procedures, etc. It is your responsibility to pay for non-covered services. After insurance claims are paid, remaining balances on your account are your responsibility to be paid in full, within the regularly scheduled billing cycle of 30 days. 

•    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. It is the patient’s responsibility to know if our office is participating with his or her plan.

Self-pay Accounts

Patients without insurance are expected to pay for services at the time of the visit. Financial needs are understood by this office, please ask to speak with our billing department to discuss a mutually agreeable payment plan, or information on additional resources that maybe available.  

Missed Appointments

There will be a $20 charge for appointments canceled with less than 24-hour notice. If more than two appointments are missed without prior notice to our office in a two-year period, we reserve the right not to schedule any further appointments. Terms subject to change without prior notice.

Returned Checks

A returned check charge of $30 will be payable by cash or money order along with the fee for insufficient funds rendered by the bank. A returned check may be cause for providing services on a cash-only basis. 

Outstanding Balances 

If previous arrangements have not been made with our finance office, any account balance outstanding over 90 days will be forwarded to a collection agency.