INSURANCE INFORMATION

Please review the following financial responsibilities and if you have any questions, please do not hesitate to contact us.

• Please advise us of any changes in address, phone number, marital status, place of employment, or insurance that have occurred since your last visit, or since this procedure was scheduled. It is your responsibility to provide us with your current insurance information.

• As a courtesy to our patients, we will submit medical claims to your primary and secondary insurance carriers. We are always here to assist you, but we rely on you to provide us with current insurance information.

• You are ultimately responsible for all fees related to your care. If your insurance does not cover the full amount of your bill, you will receive a bill for the remainder of the charge. It is your obligation to pay this within 30 days. A statement of your account is sent to you monthly.

• You may receive separate bills from the different providers involved in your care. Coastal Urology charges do not include facility or other ancillary services.

• Your health insurance policy is an agreement between you and your health insurance carrier. If you feel that your insurance provider handled your claim incorrectly, please contact your insurance company directly.

• We wish to stress that financial responsibility for services rendered is ultimately the responsibility of the patient or his or her family regardless of the nature or extent of insurance coverage. If your insurance provider does not pay your bill in a timely manner, you will be responsible for payment of the bill. If you pay a bill that is later paid by your insurance company, you will be refunded any overpayment.

REFERRALS

If your insurance requires a referral, it is your responsibility to make sure you have the referral at the time of service, otherwise this may lead to excessive delays or rescheduling of your appointment. If you fail to obtain the necessary referral, you will be responsible for your bill, in full.

PAYMENTS

All co-pays are to be paid at the time of service. If you are unable to pay at that time, we will need to reschedule your appointment. There will be a $25.00 fee for disability form completions.

Some elective surgeries may require partial or full prepayment of the patient due portion before they can be scheduled. You will need to bring all insurance cards with you on the first visit. Payment will be requested at the time of service if these are unavailable.

CONDITIONS NOT COVERED

There are certain diagnoses that are not covered by your insurance. If we do not participate with your insurance company, you will be responsible for your entire bill. Please refer to your insurance booklet or contact your insurance company regarding your benefits.

BILLING QUESTIONS

For billing inquires, please call (732) 840-9744  between 9:00 a.m. and 5:00 p.m., Monday through Friday.