Financial Policy:

We appreciate you choosing us for your healthcare. We adhere to the following financial policy in order to consistently deliver high quality care and services. The patient / responsible party assumes responsibility to ensure that the financial obligation is fulfilled for the health care services received.

The patient is responsible for all co-payments, amounts applied to deductibles, and any other amounts that may be deemed my responsibility by the payment sources, as required by the patient’s contract with my insurance plan and state regulations. Understand that if you (the patient) have an insurance co-payment, you (the patient) are expected to make payment when checking in for your appointment.

Medical insurance is an agreement between you (the patient) and your insurance company. You are ultimately responsible for payment of your bill regardless of the amount covered by insurance. Accounts that are 120 days past due from the date of treatment will be turned over to collections. Your payments may be made by cash, credit card, HSA, or FSA.

Understand that your contract with your insurance entity may or may not cover some services. Even though the Practice operates within an insurance model, some insurance companies will not allow / pay for telemedicine services. In the event the claim is denied, the patient will be responsible for payment of the applicable self-pay rate. All insurance policies are not the same. They vary by employer group. The Practice is not responsible or able to know every policy available. It is the patients responsibility to verify applicable coverage prior to receiving the services. For example, not all health plans include screenings as a benefit. If the patient seeks care outside of the contract terms, the patient may be responsible for all charges that are incurred.

Services Provided Solely on Self-pay Basis. The above information applies to the vast majority of services the Practice offers; however, there are some services, listed below, that the Practice will only provide to patients on a self-pay basis. The patient is solely responsible for, and agrees to pay, the Practice's self-pay price for such services, in full. The following services are subject to this paragraph:

• Bioidentical Hormone Pellets

Cancellation Policy:

A charge of $75 will be assessed for each No Show or Late Cancellation (less than 24-hours' notice) for regular medical appointments. A charge of $200 will be assessed for each No Show or Late Cancellation (less than 48-hours' notice) for surgical/medical procedures.

CREDIT CARD ON FILE: Understand FeMD Gynecology requires credit card information on file and will require authorization to charge a patient’s credit card on file to adhere to the No Show/Late Cancellation Policy. ALL SALES ARE FINAL. No monetary refund will be given on sales of products or services.

In Office and Surgical Procedure Deposits:

A $500 Surgery deposit will be required for all in office sedation cases and hospital surgical procedures. This will go towards any remaining balance after your insurance has been filed or towards your patient balance.

A $250 Procedure deposit will be required for all in office non-sedation procedures. This will be applied toward any patient balance after insurance has paid or toward any cash pay balance for your procedure.