For Our Patients

Financial Policies

Doctor and nurse at a workstationInsurance Policy

Our office is committed to providing quality and cost‐effective healthcare to our patients. It is essential that you understand what services are covered by your insurance plan and obtain all authorizations prior to your appointment. Your doctor may recommend services he/she feels are beneficial but may not be covered by insurance. It is your responsibility to understand the limit and restrictions affecting coverage for these services. It is your responsibility to provide us with your most current billing information. Insurance reimbursement is a contract between you and your insurance company. As a courtesy to you we file all claims for you. We will require a current copy of your insurance card in order to do this and will need to be informed of all changes in insurance status. We accept Medicare, Medicare Advantage, Blue Cross (all networks), Cigna, Tricare, Aetna, CoverKids, United Healthcare, and all Tenncare plans. You will be responsible for all co-pays, deductibles, co‐insurance amounts along with the entire amount of any non-covered services. Payment for services is expected at the time of service.

Self Pay Policy

Patients who do not have insurance coverage (or proof of insurance) or who choose to pay for non-‐covered services are required to pay a $75.00 deposit at the time of service. The $75.00 is not the cost of the office visit but only a deposit.

If any additional charges are incurred, they will be billed to the patient at a 20% discounted rate. If your office visit is determined to be less than $75.00 and no additional charges are incurred, we will issue a refund to the patient or guarantor listed on the account.

Preventive Care Services

Your health plan may not provide benefits for preventative services. It is important you determine if your plan offers benefits for this service and their guidelines for it. We use industry standard codes and guidelines to submit insurance claims based on the encounter and documentation in the medical record.

Billing Policy

We will send a statement (to the billing address you provide) notifying you of any balances you may owe. If you have any   questions or dispute the validity of any balance, it is your responsibility to contact our billing office within thirty (30) days after the receipt of the initial statement. Patient balances not paid in full within (30) days of the statement issue date are   deemed past due. For your convenience UT Family Medicine Center accepts several forms of payment including: Cash, Personal Check, MasterCard, and Visa.

Past due accounts may be referred to a professional collection agency for further collection activity. If you are not able to pay the balance due in full, you must contact our billing office to discuss a payment schedule. Under administrative guidelines, if your account has been sent to collections, UT Family Medicine Center will not be able to provide services for you or your family until your account has been paid in full.