We believe that your under understanding of our financial policies is important to you. We are committed to providing you with outstanding medical care and customer service. If you have any questions about your account please ask to speak with your doctor's Account Representative.

• Driver's license
• Insurance identification card
• Health insurance claim forms
• School insurance claim forms (filled out and signed by the coach or school administrator)

We expect payment at the time of service. For your convenience we accept VISA, Mastercard, personal checks, and cash. If the total payment is not received at the time of service you will receive a monthly statement. We do require a payment each month on your account until the balance is paid.

We will bill your insurance company if we have an agreement with them. We will do all the paperwork for you. If you have a PPO or HMO insurance plan then we will collect the required co-payment and any deductible that is due at the time of the visit. If your insurance company determines that a service is "non-covered", we will bill you for the balance due. Any amount not paid by your insurance company within 30 days may be billed to you for payment.

If we are not included in your insurance coverage or cannot verify coverage, then payment in full is expected at the time of service. Upon request, we will give you the necessary information to file your own insurance claim.

We do not accept Medicare assignment. If you have Medicare, we will bill your Medicare insurance and supplemental carrier for you. We will collect co-payments at the time of service and bill you for any remaining balance. If you are covered by Medicare and your secondary insurance is a PPO or HMO plan, we will handle the insurance billing for you.

For patients who are involved in a liability lawsuit or third party accident, payment in full is expected at the time of service. We do not provide care on a contingency basis.

If you do not have insurance, payment in full is expected at the time of service. If you have a financial hardship, special arrangements for a payment plan may be made with our business office.

Please tell the front office if you have been injured on the job. Some of our physicians do not handle workers' compensation cases and we wish to make an appropriate referral. Prior to seeing the doctor, we must verify the date of injury, the case number, the Workers Comp. insurance carrier, and the claim adjuster's name and telephone number. If we are unable to verify this information then payment in full is expected at the time of service.

If you need to have surgery you will be notified of the amount of your surgical deposit by your surgeon's Account Coordinator. This amount is estimated by our billing department based on your insurance coverage. We require that the surgery deposit be paid before surgery. If the deposit cannot be paid before surgery, then you must sign an agreement that shows the surgery deposit and a payment plan. Your actual amount due will be determined when your insurance company makes payment and may include part of your deductible and co-insurance as determined by your insurance coverage. Any remaining balance on your account will be billed to you after your insurance company makes payment.

Our staff is required to review and update insurance information on a regular basis. Insurance plans and benefits change often and we want to make sure that your coverage information is accurate.

• Regardless of your insurance coverage, the balance of your account is your financial responsibility.
• For preferred provider coverage (PPO/HMO plans) any co-pay, deductible, co-insurance, or non-covered services are your financial responsibility.

Please feel free to call the Sports Medicine Clinic of North Texas at the Landry Center at 214-824-7744 if you have any questions reguarding your account.