Procedures & Policies

Prime Care Family Practice Financial Policy

Prime Care Family Practice is committed to providing high-quality, comprehensive family health care and personal service to our patients. For every commitment, there is an obligation. It is the patients’ responsibility to meet their financial obligations. As we see patients from many different insurance plans, it is impossible for us to be certain of all the covered benefits, copays and deductibles for each individual plan. While it is our intention to assist you, it is still your responsibility to ensure that all services rendered or referred by Prime Care Family Practice on your behalf are paid in full. In order to clarify Prime Care’s Financial Policy, we have listed below our financial requirements:

Insurance Billing

Charges incurred for services rendered are the patient’s responsibility regardless of insurance coverage. As a courtesy, Prime Care will submit claims to your primary and secondary insurance carrier for the medical services that we provide to you or your dependents. Please realize that having secondary insurance does not necessarily mean that your services will be 100% covered. Secondary insurances typically pay according to a coordination of benefits with the primary insurance. In order to properly bill your insurance company we require that you disclose all insurance information including primary and secondary insurance, as well as, any change of insurance information. Failure to provide complete insurance information may result in patient responsibility for the entire bill. Remember, it is your responsibility to provide us with accurate insurance information and to inform us of any changes in your coverage as they occur. We accept many insurance plans, but cannot guarantee their coverage of services or payment.

Copays, Coinsurance and Deductibles

Copays, coinsurance, deductibles and non-covered services are due at the time of service and will be collected upon check in by the registration staff. We accept cash, debit card, check (except starter checks), Visa, MasterCard, Discover and American Express. In the event that we make an exception due to an emergent circumstance and allow you to be seen without paying your co-pay at the time of service, there will be a billing fee of $15.00 added to your account. We ask that you pay your co-payment and the billing fee within fifteen (15) days. This exception is only made for patients whose accounts are in good standing.

Uninsured or Self-Pay

Patients Payment is required at the time of service. Uninsured patients will receive a “same-day discount” which is a 20% discount on their charge. Without knowing the exact care that will be provided prior to the actual visit, self-pay patients will be required to pay $85 towards the visit and will be asked to make payment arrangements for the balance. New patients and patients that are scheduled for a physical or procedure must pay $120 towards the visit and will be asked to make payment arrangements for the balance. Extended payment arrangements are available if needed. Please ask to speak with a billing coordinator to discuss a payment plan.

The billing department can be contacted by calling 804-526-1111, option 3, Monday – Friday from 8am until 5pm. It is never our intention to cause hardship to our patients, only to provide them with the best care possible and the least amount of stress.

Balance Owed or Past Due Accounts

Unless an acceptable payment plan has been made with our billing department, account balances are to be paid in full by your statement due date. If you fail to keep the terms of your payment plan without contacting us further, we will be forced to turn your account balance over to an outside collection agency. In the event that your account is turned over to a collection agency, you will be responsible for all collection costs including reasonable attorney’s fees. Please be advised that there is a finance charge of 1.75% per month on all past due balances.

Patient Payment Responsibilities

It is the patient’s responsibility to understand his/her benefits and to keep us informed of any changes. Ask your insurer about any policy exclusions, including pre-existing conditions and verify deductible amounts. You should also verify your plan coverage for physicals, immunizations and preventative services. This helps us better accommodate the patient at time of service and helps the patient to better anticipate any out of pocket expenses. Please note, even if they cover an annual physical, your insurance company may not pay for additional problems that are addressed during the well exam. For physical exams or annual wellness visits that require additional services beyond the scheduled physical, an additional charge will be incurred and you will be responsible for payment of the resulting copay, coinsurance or deductible amount.

The patient or his/her legal representative is ultimately responsible for all charges for services rendered. Please call your insurance company directly if you are unsure whether a service is covered by your plan.

NSF/Returned Checks

There is a $30 fee for any check returned by the bank. If a check is returned on your account, we will no longer be able to accept checks and your account will be made cash/credit only.

Workers Compensation, Auto Accidents or Personal Injury Claims

Our practice does not provide care for Workers Compensation (work injury) cases. Ask your employer for a referral to a participating Workers Compensation provider. We do not accept auto accident or personal injury insurances. If you have a visit related to any of these conditions, full payment is expected at the time of service. Due to the length of time it takes to settle these types of accident claims, we are unable to bill the attorney or third party insurance. Upon request, our office will provide you with a copy of your statement so you can bill the responsible party.

Refunds

For your convenience, Laboratory Corporation of America has a draw station located in our office. The phlebotomist will send your lab specimens to either LabCorp or Quest, based on insurance, but they can only process an order from Prime Care. These services will be billed separately by the laboratory so please contact LabCorp or Quest directly for questions related to any billing for laboratory services. To ensure accurate billing and processing of lab services, make sure you give the phlebotomist your most recent insurance information.

Prescription Drugs and Referrals

Prescription drug insurance or specialist referral authorization by your insurance plan may take up to two weeks for the carrier to approve or deny. We focus on your health care and provide you with what we believe is the best prescription or referral for treatment. Employers change insurance plans and insurance plans change pharmacy benefit managers frequently. If you have issues with an insurance company not covering/approving specialist visits, prescriptions, or delaying authorizations, please contact the insurer directly.

Please be sure to bring all current medications to every appointment. Whenever possible, prescription refills should be obtained when you come in for your appointment. If needed, allow a minimum of 2 business days for refills requested outside of your scheduled appointment.

Missed Appointments, Cancellations and Late Arrivals

There will be a missed appointment charge of $25 if you fail to cancel your appointment within 24 business hours prior to the scheduled appointment. After the third occurrence, any patient who fails to cancel an appointment may be discharged from the practice.

Patients who arrive more than 15 minutes after their scheduled appointment time will be asked to reschedule. New patients are asked to arrive 30 minutes prior to their scheduled appointment time and will be rescheduled if they fail to arrive on time.

FMLA, Disability and Form Completion

There is an administrative fee for completing forms such as FMLA, DMV, leave of absence, disability, sports, school or daycare physicals etc. Depending on the complexity of the form, the fee will be $15 – $40. A minimum prepayment of $15 per form is required. Understand that these forms can be quite complicated and tedious and require a significant amount of the providers’ time. Most forms will require five to six working days to research information, review the chart, copy and complete the form. All forms, and any questions regarding their fee and completion, should be given to our Administrative office.

Medical Records

MediCopy handles the processing of all requests for medical records. Please call MediCopy directly for billing inquiries.

Refunds

In the event an overpayment was made, the refund will be issues to the appropriate party. Patient refunds will not be processed until all active or past due balances are paid in full. Refunds are processed at the end of each month. Please call our billing office if you have any questions regarding this policy.

Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area. Thank you for understanding our payment policy. Please let us know if you have any questions or concerns.