L. Carney MD / AllMedPhysicians, pLLC believes that part of good healthcare practice is to establish and communicate a financial policy to our patients. We are dedicated to providing the best possible care for you, and we want you to completely understand our financial policy.

2. INSURANCE We are participating providers with several insurance plans. We will file these insurance claims with those with which we participate. A list of these insurance plans is available upon request. Please remember that insurance is a contract between the patient and the insurance company and ultimately the patient is responsible for payment in full. If your insurance company does not pay the practice within a reasonable period of time, you will be billed. If we later receive payment from your insurer, we will refund any overpayment to you. Our billing office number = (512) 535-1938

If your insurance doesn't pay Dr. Carney, you will be responsible for full payment. If you are insured by a plan with which we do not have a prior arrangement, we will prepare and send the claim for you on an unassigned basis. This means the insurer may send the payment directly to you and therefore, our charges for your care are due at the time of service. Due to the many different insurance products out there, our staff cannot guarantee your eligibility and coverage. Be sure to check with your insurer member benefits department about services and physicians before your appointment. You are responsible for obtaining a properly dated referral if required by your insurer and responsible for payment if your claim rejects for lack of one.

Not all insurance plans cover all services. In the event your insurance plan determines a service to be not covered, you will be responsible for the complete charge. Payment is due upon receipt of a statement from our office. All procedures billed in this office are considered covered unless limited by your specific insurance policy.

3. LATE CHARGES of 12 % annually will be applied to all patient balances of 90 days or older.

4. RETURNED CHECKS will incur a $30.00 service charge. You will be asked to bring cash or a money order to cover the amount of the check plus the service charge.

5. ACCOUNTING PRINCIPLES Payment and credits are applied to the oldest charges first, except for insurance payments which are applied to the corresponding dates of service.

6. COMPLETING INSURANCE FORMS, COPYING MEDICAL RECORDS, ETC. Requires office staff time and time away from patient care for our doctors. Copies of Medical Records will be available for you to pick up at the office no later than 30 days after we receive the payment for the copies, along with the signed release authorization for the records. Copies cost $1.00 for the first page and $0.10 for each additional page. We may require pre-payment for completing forms, copying medical records, or for extra transcription by the doctor. The charge is determined by the length and complexity of the form or letter. FMLA and disability forms, as well as camp physical, sports physicals, and other forms, are a minimum of $10 each, even if filled out as a result of an office visit or without an office visit.

7. If you have questions in regard to any of your billing statements our accounts receivable staff is available to assist you. Our billing office number is (512) 535-193

8. Billing fees for co-pays not paid up front: I agree that all co-pays and deductibles and patient portions are due at the time of service and agree to pay these up front before seeing the physician for my appointment time. I understand that failure to pay the co-pays or patient portions that I owe will result in a $20 billing fee to be added to each date of service for which I have not paid by the time I enter the exam room to see the physician.