As a patient of the Polyclinic, you already know that our physician-owned and run philosophy means that nothing gets in the way of doing what we think is best for your care.
In addition, you accept financial responsibility for the medical care you receive from us. Please review our financial policies listed below, review and understand your health insurance coverage and don’t hesitate to contact us if you have any questions.
Annual Physical and Preventative Care
Some medical plans do not provide reimbursement for annual physicals or other related services i.e. lab, vaccines. It is important that you are aware of your specific benefits and limitations to avoid being held financially responsible.
Advanced Beneficiary Notice and Waiver Forms
Certain visits and procedures may not be covered by your insurance plans. You may be asked to sign a form that states you could be financially responsible for services provided.
Insurance and Registration
The Polyclinic participates with most major insurance carriers. It is your responsibility to provide us with information necessary for billing including, your current address, phone number and a copy of your insurance card at each visit. You will receive a statement each month for any balance left on your account. Your insurance is a contract between you and your insurance carrier, which may not cover all your care. We cannot accept responsibility for non-covered insurance claims or negotiating a disputed claim.
Some insurance plans require you to have a referral or a pre-authorization prior to your appointment. It is your responsibility to ensure this has been obtained. If we do not have this required referral or pre-authorization then your insurance carrier may deny payment, and the resulting balance becomes your responsibility.
Collection of Insurance Co-payments, Co-Insurance and Deductibles
All co-payments are due at the time of service. Remaining balances are due upon receipt of your Polyclinic statement. For your convenience we accept cash, checks, debit cards, and most credit cards.
If you don’t have insurance coverage, please be prepared to pay $250 for your initial visit and $100 for each subsequent visit with the same provider. If additional services (such as Labs or X-rays) need to be performed, we may request additional deposits.
There will be a $25 charge for checks returned due to non-sufficient funds (NSF), closed accounts, etc.
Special Payment Arrangements
We understand that there are times you may not be able to pay your bill in full. It is your responsibility to call our business office to make special payment arrangements. Failure to maintain your account in good standing could result in your discharge from The Polyclinic for future care.
Missed Appointment without Appropriate Notice
We require a 24 hour notice if you need to cancel or reschedule your appointment or procedure. Procedures outside a physician office may require 72 hour cancellation notice. If appropriate notice is not provided you may be subject to a No Show Fee in the amount of $75.00.
Motor Vehicle and Third Party Billing
Motor vehicle and third party injury claims are your financial responsibility. We will provide documentation for you to submit as evidence of services rendered in order to have claims paid. We do not do third party billing.
Contact our Customer Service department at 206-860-4500 Monday through Friday, 8 a.m. to 4:30 p.m.