Billing & Financial Policies

Dr. Washburn, Dr. Brimhall and Dr Reagan recognize the importance of the successful operation of our practice. It is our hope that you will understand that our financial policy is a necessary partof assuring the financial resources required to maintain the vital health care services for our patients and the community. Our goal is to set standards that will provide our patients with the highest quality medical and surgical care.

Our office is on a computerized billing system. Patients will continue to receive a statement as long as all or part of any portion of the bill remains unpaid.

PPOs, HMOs, Managed Care and other Contracted Plans-We are contracted with a variety of managed care and insurance plans to provide specialist services. Some of these plans require the patient to have a primary care physician. You may be required to obtain a referral or authorization from either your primary care physician or your insurance plan before any services can be provided to you. You are required to pay your co-pays at the time of service.

Medicare-Part B-We are participating physicians with the Medicare program. You are responsible for your yearly deductible and 20%o of the allowable charges. Please advise us if Medicare is your secondary payor. If you only have Medicare Part A, you do not have coverage for physician charges.

Supplemental Insurance-If you have supplemental coverage we will automatically submit your claims if you have supplied us with the insurance information. If your supplemental plan pays you, we expect you to forward those payments to us.

Non-Contracted Insurance-Payment is expected at the time of service and we will give you all the information you will need to bill your own insurance. All medical expenses are the patient's responsibility regardless of insurance coverage.

Cash-No Insurance Coverage-Patients who have no insurance coverage are considered "Self Pay"and are expected to pay at the time services are rendered UNLESS other arrangements have been made inadvance with the billing office. For large surgery balances, the hospital will assist you in applying for AHCCCS. If you are not eligible for AHCCCS and there are special considerations, you may apply for aFinancial Agreement with our office. We also take VISA and MasterCard.

Workers Compensation-if you have a work-related or industrial injury/illness, you must report this to your employer and complete a "pink" Worker's Report of Injury for the Industrial Commission of Arizona and advise us of the name and address of the work comp insurance carrier. We are required to obtain authorization from the industrial carrier for any surgical procedures and certain diagnostic tests. Any claim denied as "non-industrial" or "closed" may be billed to your medical insurance carrier or will become your responsibility.

Automobile or Motor Vehicle Accidents, Legal, Lien- Regardless of litigation pending on any case,accident or otherwise, you are responsible for payment of any and all services rendered to you. Payments cannot be contingent on any settlement, judgment, or verdict for which you may be paid as a result of your injuries. We do not accept liens. We expect payment at the time of service. We will not wait for automobile or third party insurance settlements.

IHS, CHS, AHCCCS or "AHCCCS Potential"- You must produce your ID card at each visit. If you are no longer eligible or we can't verify your eligibility, you will be responsible for payment of our charges. If you are "AHCCCS Potential" it is imperative that you apply for coverage within 48 hours from the time of medical care. Failure to follow through will result in you being totally responsible for payment.

Paying your bill- if unusual circumstances make it impossible for you to pay for services in full or to meetour terns, we invite you to call or come in to discuss the matter with our billing office. This will avoid misunderstandings and keep your account in good standing. Except when hardship or prior credit arrangements warrant, accounts over 90-days past due are referred to our collection agency. All collection expenses will become your responsibility, if your account goes to collection you will be discharged from the practice. If you have any questions, please ask! We will assist you in any way we can. We accept VISA and MASTERCARD. Returned checks incur a $25.00 service charge and all accounts extended past90-days will be charged a S5.00 re-billing fee per month. We do not assess finance charges.

Appointments- A certain amount of time and preparation goes into your visit. lf you are unable to keep your appointment, please give us 24-hours notice. To make or change an appointment call (928) 5378177.For emergencies our telephone is answered 24-hours a day,7 days a week. Our office hours are 8:00 am to5:00 pm Monday through Fridays, except holidays. We usually close for lunch and these times vary. We sometimes, but rarely, close the office when there are no physicians in the office.

Prescription refills- As our physicians are often in surgery or at the hospitals and not available in the office, please allow a minimum of 4 business days for prescription refills whenever possible. No refills or requests for medications will be considered on weekends or holidays.

Information- It is your responsibility to make sure that we have accurate and up-to-date informationfor billing your insurance. It is also important to advise us of any changes to your name, address,and telephone numbers.