• Midtown Medical Plaza
  • 1918 Randolph Road
  • Suite 600
  • Charlotte, NC 28207
  • 704-342-0252
  • Click for Directions
  • Piper Glen Location
  • 7810 Ballantyne Commons Parkway
  • Suite 300
  • Charlotte, NC 28277
  • 704-342-0252
  • Click for Directions

AOCC States Logo with name 4We understand that financial and insurance issues can be stressful and confusing for patients. We want to do everything possible to ease your financial worries so you can concentrate on getting well. As an AOCC patient, you have the added advantage of dedicated staff who work to ensure you receive your full insurance benefits. We don’t want you to get over-whelmed by insurance paperwork. Simply call the AOCC Business Office at (704) 342-0252 and we will assist you.

With the monumental changes in the healthcare system over the last few years, both patients and healthcare providers now carry a greater burden in understanding and complying with guidelines outlined in individual insurance plans. Patients who do not follow the guidelines of their particular insurance coverage may be responsible for payment of fees and services; therefore, it is important that patients determine what their coverage allows prior to beginning treatment.

Thank you for choosing us as your healthcare provider. We are committed to providing quality medical care. Please understand that payment of your bill is considered part of your care plan. We ask you read and sign this Financial Policy prior to any treatment . Please let us know if you have any questions.

• We will verify your insurance coverage at every visit. It is your responsibility to supply all current insurance cards. Failure to provide accurate information in a timely manner may result in claim denial, thus making you liable for any outstanding balances.

• No show FEE of $25.00 will be charged to your account for not canceling your appt. 24 hours in advance.

• Consults and new patient appointments must be cancelled 2 business days prior to appointment. It will be your responsibility to pay $85.00 if this is not done.

• Full payment including but not limited to deductibles and/or co-insurance, is due at the time of service for those with or without co-pays.

• We accept cash, checks, money orders, Visa, Discover, and Master Card. A $30.00 fee will be assessed for returned checks.

• It is the patient’s responsibility to know and understand the terms of their insurance policy; in/out of network, deductibles, coinsurance, co-pays. If you are unsure of your plans policies please contact the Business Office and someone will be able to assist you.

• Payment plans have a minimum monthly requirement and must be set up on a monthly automatic bank draft. Contact the Business Office at (704) 342-0252.

• When labs, x-rays, or other tests are ordered by AOCC, you are responsible to check with your insurance company as to where you are authorized to have these studies done. We will not be responsible for any bill if you have a test done at the wrong location.

• In the event your account goes into default, a charge of 25% interest will be added to your principal balance.

As a courtesy to our patients, we will submit claims to your insurance carrier for you. For those plans that we participate in, we will also submit secondary insurance claims. Insurance plans vary considerably, and we cannot predict or guarantee what part of our services will or will not be covered by your particular plan.

I hereby authorize AOCC to release any medical information required in the course of examination and treatment and permit payment directly to them any benefits due for their services rendered. I recognize and accept responsibility for services rendered regardless of insurance coverage. This includes but not limited to co insurance, co-payment, deductible and non-covered services.

I___________________________________have read, understand and agree to the Financial Policy (Above)

___________________________________________________________________Signature of Patient or Responsible Party

____________________________________________________________________Date

**This is a read only document** When you come in for your appointment you will be asked if you have read and understand, or have any questions about this Financial Policy. You will be asked to sign this Financial Policy at check-in.