Katy Foot Dr.'s

OFFICE POLICY

Welcome to our office! Our goal is to provide the best podiatric care available for each of our patients.

Charges for services are what we determine to be usual and customary fees for the professional services provided. We will be happy to provide all necessary information for any insurance claims related to treatment or surgery rendered in our office and/or surgical facility. However, due to the many varieties of insurance plans available, we have no way of determining what the insurance plan coverage will be in each individual case. There is a wide variation between insurance companies concerning benefit fees. We will verify your coverage, however the information the carrier provides us with is NOT our responsibility. YOU should contact your carrier since the agreement is between you and your carrier. Any charges not covered by your insurance will be your responsibility. Also, be advised that any claims not paid by your insurance company within 45 days will become your responsibility.

ALL INSURANCE INFORMATION MUST BE ACCURATE AND UP-TO-DATE. THIS IS YOUR RESPONSIBILITY. YOU WILL BE BILLED FOR SERVICES IF THE INFORMATION IS INCORRECT. IF YOU CHANGE CARRIERS, YOU MUST NOTIFY OUR OFFICE.

The federal government has informed us that we can be prosecuted for not charging and collecting the co-payment, therefore the co-payment will be collected before each office visit for HMO's and PPO's. Deductibles, if applicable, must also be paid before services are rendered.

Insurance companies may require pre-certification, pre-determination, or second opinion. X-rays or other necessary records will be provided for your convenience, however, 3-5 days notice is required for duplication. NO ORIGINAL X-RAYS are released to patients. NO EXCEPTIONS.

I authorize the release of any medical information necessary.

If you have any questions regarding our fees, professional services, or individual problems, please feel free to bring them to our attention.

Thank you for your cooperation.


____________________________________________
Patient or Guardian Signature

_____________________
Date


APMA Logo

Refer a Friend

Advanced Diagnostic Foot & Ankle Specialists of Katy

21720 Kingsland Blvd.
Suite 303-B
Katy, TX 77450
Tel: 281.579.5670
Fax: 281.579.5671
VIEW MAP >>