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CANCELLATIONS

Cancellation of an appointment is sometimes unavoidable due to medical problems or significant conflicts which cannot be avoided. Please provide us with at least 24 hours advance notice if you need to cancel or reschedule an appointment. We may charge a $50.00 fee for missed appointments.

Please provide us with at least 48 hours advance notice if you need to cancel or reschedule an appointment that requires an interpreter. Appointments requiring an interpreter not canceled or rescheduled within 48 hours may be charged for the interpreter.

 

 

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MEDICAL RECORDS

Here at Puyallup Surgical Consultants, confidentiality of your medical records is a top priority. We comply with all HIPAA requirements so you can be confident your medical records are safe and secure.

We can only release records with properly signed consent forms. Release Authorization and other forms can be found in our forms page.

 

A copying and mailing fee may be applied for lengthy medical records.

 

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FINANCIAL MATTERS

Puyallup Surgical Consultants, a division of Proliance Surgeons is committed to providing you with the highest quality medical care. Because patients are ultimately responsible for the charges associated with their care, even when insurance is in place, you may find the following information helpful. We realize you have choices for your medical care and appreciate your choosing Puyallup Surgical Consultants. 

Patient Responsibilities

You can help ensure an efficient experience by assisting with the following:

  • Providing us with your picture identification, insurance card and Social Security number to enable us to submit your claims timely and accurately
  • Knowing your insurance benefits and limitations
  • Ensuring there is an authorization for our providers to threat you if it is required by your insurance, including obtaining a referral
  •  Providing us with copies of any pertinent medical records, including tests (MRI/CT/Arthrogram) and x-rays
  • Paying your estimated portion of the charges prior to the date of service
  • Paying any additional amount owed when due
  • Completing required incident/accident forms within 30 days of date of service
  • Maintaining a current account with Proliance Surgeons at all times
  • Providing us with at least 24 hours advance notice should you need to cancel or reschedule an appointment

Please note that co-payments, co-insurance and deductibles  are a contractual agreement between you and your insurance carrier. We cannot change or negotiate these amounts.

Insured Patients

We will bill your primary and secondary insurance carrier in a timely manner. If you are disputing payment with your insurance carrier or have a balance over $100.00 with us, you must notify our business office and make payment arrangements.

Co-Pays/Deductibles/Co-Insurance – Please be prepared to pay for your portion of the charges on or before the date of service.

Surgery – If surgery is indicated, a pre-payment of both physician and facility fees is required for all elective non-emergent procedures prior to the surgery being performed. Your out-of-pocket cost is estimated based on your benefits and our fees. Anesthesia and other providers are separate fees. 

Non-Participating Insurance – If we do not participate in the insurance you have, we will file a claim as a courtesy. All unpaid claims will become your responsibility 45 days following filing and be immediately due and payable.

Uninsured Patients

Office Visits – A $175.00 deposit is required prior to the appointment. If visits and services are paid in full at the time of service, we offer a 20% discount (see exclusions below). Office visits may include x-rays, casting and materials at an additional charge. Charges are not finalized until chart notes are complete. 

Surgery – For uninsured patients, we offer a 20% discount when charges are paid before the day of service (see exclusions below).

Exclusions – The discounts referenced above do not apply in cases of motor vehicle accidents, third party insurance claims or in other cases when the patient may be reimbursed in full. 

Private pay patients who receive retroactive Medicaid coverage need to immediately notify our business office. 

Motor Vehicle Accidents (MVA) Insured and Third Party Patients

We do not extend discounts for MVA-insured accidents, third party insurance claims or in other cases when patients may be reimbursed in full. We will bill the MVA insurance carrier one time. The bill becomes your responsibility if not paid by the carrier in 30 days. We regret that we are not in a position to confer with attorneys or defer payment obligations while a case settles. If your personal injury protection benefit on your MVA policy is exhausted, we will bill your private insurance at your request provided we are furnished the necessary information at the date of service. 

Workers’ Compensation

If your visit is work-related, we will need the case number and carrier name prior to your visit in order to bill the workers’ compensation insurance carrier. If your workers’ compensation claim is not yet accepted and you have no other insurance we require a $175.00 deposit that will be refunded after the claim has been opened. 

Other Charges

No Show – Please provide us with at least 24 hours advance notice if you need to cancel or reschedule an appointment. We may charge a $50.00 fee for missed appointments.

Please provide us with at least 48 hours advance notice if you need to cancel or reschedule an appointment. Appointments requiring an interpreter not canceled or rescheduled within 48 hours may be charged for the interpreter.

Forms – There may be a charge associated with our completion of some forms. We require payment of the  charge before returning the completed form to you. A signed Release of Information may also be necessary. Please allow five business days for us to complete forms. 

Payment

Payment Options – We accept cash, checks, major credit/debit cards and money orders for payment (no post-dated or third party checks). We charge a $40.00 NSF fee for any returned checks.

Delinquent Accounts – We charge a $10.25 monthly account management fee on balances over 30 days old. We may assign an account to collections if balances are unpaid after 60 days. Patients assigned to collections may be denied additional services.

Alternative Payment Arrangements – We do not offer payment plans at this time. 

Bankruptcy/Prior Bad Debt – Patients who have previously filed for bankruptcy or never satisfied their payment obligation for prior episodes of care with Puyallup Surgical Consultants or other Proliance Surgeons care centers may be required to pay for their portion of new charges at the time of service. 

 

 

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PRESCRIPTIONS

Please contact your pharmacy for prescription refills.  Allow 48 hours for your refill to be processed.

 

 

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