Office Policies

1. PAYMENT IN FULL BY CASH OR CHECK 
A bookkeeping courtesy of 5% is given for payment in full for the total cost of treatment if paid on or before the date of service by cash or check (applies to surgeries and major procedures only).  The estimated insurance portion will be refunded to you. 

Please allow 90-days, from the date of service for refund to be issued.

2. PAYMENT IN FULL BY CREDIT CARD, DEBIT CARD OR CAPITOL ONE HEALTH CARD 
We accept VISA, DISCOVER, and MASTERCARD.  See item “C” listed below for Capital One Healthcare Financing information.
No discounts apply when payment are made with a credit card, debit card, CITI, or CHASE credit line.

3. PAYMENT OF ESTIMATED “OUT OF POCKET” PORTION
Payment of your Estimated Patient Portion is due in full on or before the time of service unless financial arrangements have been made at least 5 business days* prior to your procedure appointment date. 

4. IN-OFFICE MONTHLY PAYMENT AGREEMENT BY CREDIT CARD
Payments will be automatically made for you on either the 10th or 25th of each month. 
The first payment is in the amount of 40% of the total cost of treatment and is due on or before the date of service. 
The remaining 60% of the service amount is payable in 2 monthly installments of 30% each month.
No interest will be charged to your account if payments are received or able to be processed on the 10th or 25th of each month, as agreed.
In-office monthly payment agreements will extend for no longer than 120 days from the date of service. 

If any given payment is missed or unable to be processed an interest rate of 1% per month on the remaining balance or 12% annum and a $45.00 NSF charge can apply and will be added to the remaining balance of the agreement along with any collection fees. 

Please refer to the Credit Request & Payment Arrangement document for details. 

B. IN-OFFICE MONTHLY PAYMENT AGREEMENT BY HELD CHECKS
Monthly payments may be made by check in lieu of a credit or debit card. 
Our office must obtain all checks at least 5 business days* prior to your procedure appointment date. 
Monthly deposits of the checks will be on or after either the 10th or 25th of each month of the payment plan.

No interest is charged as long as payments can be processed, on the 10th or 25th of each month, as agreed.  If any given payment is unable to be processed on the arranged date, an interest rate of 1% per month on the remaining balance or 12% per annum will apply and will be added to the remaining balance of the agreement along with any collection fees. 

Please refer to the Credit Request & Payment Arrangement document for details.

C. OUT-OF-OFFICE CREDIT THROUGH CAPITOL ONE or CHASE HEALTH 

For plans of $1,000.00 or more, you can apply to Citibank at www.healthcard.citicards.com, or to Chase by calling 1-800-510-5638 or at www.chasehealthadvance.com.

DENTAL INSURANCE COVERAGE

The full cost of treatment is ultimately your responsibility.  Should your insurance fail to meet payment expectations, you are responsible for the full cost of treatment. 

We ask that all patients with insurance coverage provide us with complete and accurate insurance submission information the time of their initial evaluation and update this information as needed.  Without this information, patients are responsible for payment in full at the time of service.

 

 

EMERGENCY BASIS
Payment in full is required for emergency services. 
Please allow 90days from the date of service for a refund to be issued.

 

 

SERVICE CHARGES & ACCOUNT DEFAULT

A service charge of $45.00 will be applied to every account for all returned checks and credit card transactions that are unable to be processed on the date of the payment plan. 

It is your responsibility to update your account information 5 business days* prior to the scheduled payment date. 

This charge will be applied each time a transaction is unable to be processed in addition to the amount due per the payment agreement, and any interest charges that have been applied to the account. 

 

Account changes made within 5 business days* of the scheduled payment date may be subject to treatment as a defaulted account and all service charges, NSF charges, interest, and other fees can apply. 

*Business days are defined as Monday, Tuesday, Wednesday, Thursday, and Friday, excluding all federal holidays, from the hours of 9:00a – 5:00p.

 

 

FINANCIAL RESPONSIBILITY & MINOR PARTIES

The terms “you”, “me”, “my”, “I”, “yours”, and “your”, refers to the party or parties financially responsible for the account.  Financial responsibility defaults to the patient, unless the patient is a minor.  A parent or guardian must be present at all times with a minor patient and sign all documentation for the minor patient. 

A written statement of financial responsibility is required for minor patients of divorced parents.   

POLICY FOR CANCELLATION OR RESCHEDULING OF APPOINTMENTS

A notice of 5 business days* is required for all surgical appointments. 

If you cancel your surgical appointment less than 5 business days in advance or miss your surgical appointment, a finance charge of 20% of the total fee planned for that appointment can be charged to your account.  

 

A notice of 2 business days* is required for all non-surgical appointments.  If you do not appear for your appointment, or you cancel within 2 business days* of your appointment time, your account can be charged a service fee of up to $50.00 for each appointment missed.

 

 

ACCOUNT COLLECTIONS

Dr. Eriks reserves the right to turn delinquent accounts over to collections.