Sample Patient Payment Agreement

A payment policy lets your patients know what you expect from them and what they can expect from you. A well-thought-out policy will prevent patients from being surprised by their financial commitment when they receive their services. There will also be some legal protection in your practice if a patient does not pay what you can move in. Of course, some patients have real difficulties in making ends meet. A doctor or a doctor`s office administrator can determine when this is actually the case. People lose their jobs, divorce or face catastrophic illness. These people need our help, and they will be really grateful if you can give them a break. Our firm strives to provide our patients with the best treatment. Our prices are representative of the usual and usual fees for our region. Once you have written your payment policy, have each patient read, signed and dated. Add it to the patient diagram.

When a patient says, “I didn`t know I had to pay my co-payment or independently” or anything, just refer to their chart. There is something about patients seeing their own signature on a document that seems to enforce them. Most insurance companies now have automated fax systems that can usually provide you with this information in minutes. With a phone call, the system faxes a description of your patient`s services at your office, including deductible, surcharges, covered services and out-of-pocket limits. This extremely valuable service can make things much easier when they approach your patient through their financial responsibility. Our office keeps these faxes in the patient`s card so that they can be easily transmitted when a question arises about coverage or liability. The payment directive below is similar to the one used in the practice in which the author works and can be used as a policy to help you develop your own (click below to download the directive). Patients are invited to read and sign a copy of the directive, which will then be attached to their subsequent reference diagram. Of course, there will be special circumstances when a staff member wants to talk to a doctor (for example.B.

when a patient has confided that he or she has just lost a job or has another financial situation; However, this should not be done before the patient. Once the payment policy is in place, it should be effective enough to deal with most situations without having to remove the doctor from the practice of medicine. Here is a simple form of download and use in your doctor`s office to establish a payment plan with patients. Proof of insurance. All patients must complete our information form before consulting a doctor. We must receive a copy of your driver`s licence and valid insurance to provide proof of insurance. If you do not provide us with the right insurance information on time, you may be responsible for the balance of a claim. Sometimes it`s helpful to work with your patients to make a payment plan for your services. Here`s a handy tool to make it easier for you to enter and here are some additional instructions from George Conomikes of Conomikes Associates.Download the form here as Word document and here as a PDF file. Premiums and deductibles.

All surcharges and deductibles must be paid at the time of service or notification. This agreement is part of your contract with your insurance. If we do not make too many co-payments and patient deductibles, this can be considered fraud.