PATIENT FINANCIAL RESPONSIBILITY STATEMENT

Please read the section that applies to your health insurance coverage:

MEDICARE & MEDICARE ADVANTAGE PLANS

We accept assignment on all Medicare claims and will bill Medicare for you. We will bill any supplemental insurance that is secondary to Medicare. We accept the amount approved by Medicare as fee and Medicare generally pays 80% of this amount, minus any deductibles or coinsurance amounts. Often, supplemental insurances will pay towards the remaining 20%. After insurance pays, we will send you a statement if there is any amount that you owe. Please pay promptly or call us if there is a financial hardship and you are not able to pay the full amount within 30 days of receipt of the statement.

PRIVATE INSURANCE

We will send a claim for services rendered to your private insurance company as a courtesy, whether or not we are a contracted provider. If Yakima Urology is not a network provider for your insurance, it is your responsibility to obtain all required referrals and authorizations for your treatment.
Many private insurance companies require us to collect a co-payment at the time of your appointment. We will collect any co-pays due upon check-in on the date of your appointment.
After the insurance company had paid their part, if there is any amount remaining, we will send a statement to you. Please pay promptly or call us if there is a financial hardship and you are not able to pay the full amount within 30 days of receipt of the statement.

Patient balances over 30 days old will be subject to external collection processes unless other arrangements are made with the Business Office.

NO HEALTH INSURANCE

Patients without insurance are required to pay in full on the day of your visit.

PAYMENT OPTIONS

We do accept credit card payments, Visa, Master Card and Discover only. If your balance is higher than you can pay at one time, please speak with a Business Office representative regarding possible payment arrangements. The minimum monthly payment for any balance over $300.00 is $100.00 per month and a financial statement is required.