Office & Finanical Policies

PLEASE CAREFULLY REVIEW AND SIGN AT THE BOTTOM OF THE PAGE TO ACCEPT.

Insurance is considered a method of reimbursing the patient for fees paid to the doctor and is not a substitute for payment. Some companies pay fixed allowances for certain procedures, and others pay a certain percentage of the charge. It is your sole responsibility to pay any deductible amount, co-insurance, or other balance not paid for by your insurance.

You are responsible for knowing if your insurance policy requires a referral to see the provider, or if there are special requirements for your insurance policy. To make your visit as easy as possible, we must have this information before you can be seen by the doctor. There may be certain routine services performed during your visit or upcoming visits that may or may not be covered. It is your responsibility to contact your insurance company prior to any procedure to see if they are covered.

If your account becomes past due, you will be turned over to a collections agency. All charges incurred to collect payment including collection agency fee, attorney fees and/or court costs, if such be necessary will be your responsibility.

Returned Checks

There is a fee of $30 that will be charged on your account for any checks that are returned by the bank. Any checks that are returned will void any previous payment arrangements and the account balance will be due in full immediately. You will be unable to write checks in the future.

Cash Services

Services that are not billed to insurance PAYMENT/PRE-PAYMENT FOR ALL CASH SERVICES ARE NON-REFUNDABLE. In the event that you are unable to complete a pre-paid treatment program/regimen, you will be allowed up to one calendar year (from the date of your first missed appointment), to complete it as prescribed/recommended by Dr. Cowan. They may be transferred towards other cash services.

Fees for No-Shows, Cancellations, Rescheduling of Surgery and Other Fees

To better serve our patients and ensure the availability of appointments, the following policy is necessary: There will be a $40 charge if you fail to cancel your scheduled appointment (24) hours prior to your appointment time. If your appointment is on a Monday, please call the Friday before your scheduled appointment to cancel or reschedule to avoid the cancellation fee.

For frequent missed appointments, we may require a non-refundable and non-transferable deposit for all future appointments. Your credit card on file will be billed $40 on the day of your visit if you fail to cancel your appointment 24 hours prior to the scheduled time. In the event, no credit card is on file, you will be billed the $40 cancellation fee, which must be paid prior to any future appointments.

If you are more than 15 minutes late for your appointment it is equivalent to a No-Show. You will be charged or billed $40 and will have to reschedule your appointment.

Surgery Cancellation Fee

A (7) day notice is required for all surgery cancellations. Cancellations with less than (7) day notice, will be charged a fee of $250.

Other Fees

There is a $25 charge for all forms, letters, FMLA forms, etc. and a $25 plus for copying of medical records.