The Kroll Medical Group Financial Policy

We appreciate that you have entrusted us with your health care. Because healthcare benefits and coverage options have
become increasingly complex, we have developed this policy which details our financial requirements to help you
better understand your responsibilities as a patient.

It is your responsibility to know if your insurance has specific rules or regulations, such as the need for referrals, precertifications, preauthorizations, limits on outpatient charges, specific physicians and/or hospitals to use. You should be knowledgeable of any deductibles, copayments, and/or coinsurance. This applies to all payors regardless of whether or not our physicians participate.

The responsibility for payment of fees for services is the direct responsibility of the patient. Your health benefit plan is
an arrangement between you, the enrollee and the insurance company, HMO or your employer. Your health benefit
plan determines your coverage, requirements, and establishes the limit on your coverage for medical services based on
what they determine as medically necessary. However, we will do our best to assist you with understanding your
proposed treatment and in answering questions related to your insurance.

Payment Policy Schedule*:

Copayments:                                          Full payment is due at time of service.

Deductible and coinsurance:                 Full payment is due at time of service.

Noncovered service:                              Full payment is due at time of service.

Nonparticipating insurance plan:          Full payment is due at time of service.

Return Check Fee $50.00 * 

Other charges/fees*:

We consider a No-Show as not calling 24 hours prior to a scheduled office visit to cancel.  When a patient does not show for their appointment, we cannot accommodate an ill patient who may need that spot. No-Shows are unfair to all patients and physicians.  Therefore, a $50.00 fee will be applied to anyone who No-Shows for their appointment *. Two No-Shows without a call will result in a discharge from the practice.  We require 24 hours notice for any appointment cancellation.  

Remember:  You may be the person looking for an appointment when another "no-show" patient is scheduled for office time.  Please be considerate and provide adequate notice of cancellation.

Completed Forms Fee:  A fee of $25 will be charged for the completion of basic letters and forms such as school, annual physical and immunization forms.  A flat rate fee of $250 will be charged for Attending Physician Statements, Disability Forms or any legal forms.  Please note that these fees are your responsibility and cannot be billed to your insurance company.

Any work required for attorneys, court appearances, subpoenas, depositions, etc will be billed at an hourly rate of $450 for work in the office.  There are additional charges for out-of-office court or deposition appearances plus travel time.  Please note that these fees are your responsibility and cannot be billed to your insurance company.

Medical Records A fee of $1.00 per page * due prior to receipt of records.

* These charges are your responsibility and not your insurance provider and will be billed directly to you.

We realize that medical care can often become very expensive. If you have concerns about your ability to pay for
service, we recommend that you contact us for assistance in the management of your account.

Should you have any questions with regard to our financial policy we encourage you to ask.

It is our goal, not only to provide the best quality of medical care, but to help you by answering any questions you might have.