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Payment Policy


Payment Policy

Thank you for choosing Dr. Wallin as your primary care provider. Some of our patients have had questions regarding patient and insurance responsibility for services rendered. We have been advised to develop this payment policy. Please read it, ask us any questions you may have, and sign in the space provided. A copy will be provided to you upon request.

1. INSURANCE. We participate in most insurance plans, including Medicare. If you are not insured by a plan we do business with, payment in full is expected at each visit. If you are insured by a plan we do business with but you do not have an up-to-date insurance card, payment in full for each visit is required until we can verify your coverage. If we later receive a check from your insurer, we will refund any overpayment to you. Knowing your insurance benefits is your responsibility. Please contact your insurance company with any questions you may have regarding your coverage.

2. CO-PAYMENTS AND DEDUCTIBLES. All co-payments and deductibles must be paid at the time of service. This arrangement is part of your contract with your insurance company. Failure on our part to collect co-payments and deductibles from patients can be considered fraud. We will bill you a $5.00 billing charge if co pay is not paid at time of visit. We accept cash and checks as form of payment.

3. NON-COVERED SERVICES. Please be aware that some-and perhaps all-of the services you receive may be non-covered or not considered reasonable or necessary by Medicare or other insurers. You must pay for these services in full at the time of visit.

4. PROOF OF INSURANCE. All patients must complete our patient information form before seeing the doctor. We must obtain a copy of your current valid insurance card to provide proof of insurance. If you fail to provide us with the correct insurance information in a timely manner, you may be responsible for the balance of a claim.

5. CLAIMS SUBMISSION. As a courtesy to you we will submit your insurance claim. Your insurance company may need you to supply certain information directly. It is your responsibility to comply with their request. Please be aware that the balance of your claim is your responsibility whether or not your insurance company pays your claim. Your insurance benefit is a contract between you and your insurance company; we are not party to that contract.

6. NONPAYMENT. If your account is over 90 days past due, you may receive a letter stating that you have 30 days to pay your account in full. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency and you and your immediate family members may be discharged from our practice.

7. MISSED APPOINTMENTS. OUR POLICY IS TO CHARGE $25.00 FOR MISSED APPOINTMENTS NOT CANCELED 24 hours prior to appointment time. These charges will be your responsibility and billed directly to you. Please help us to serve you better by keeping your regularly scheduled appointment.
Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area.



 Becky L. Wallin,  
 M.D., Inc.
 A Professional  Corporation
 2242 Camden Avenue,  #200
 San Jose, California  95124

 Phone: (408) 626-7110
 Fax: (408) 377-3996
 
(c) 2005. Becky L. Wallin, M.D., Inc