Dear Patient/Patient Guardian,
Thank you for choosing Annapolis Allergy & Asthma for your health care needs. Our primary concern is centered on you, our patient and that you receive the proper care needed to restore your health. Our financial policy is a necessary part of assuring the resources required to maintain our health care facility for our patients. We kindly ask that you read the following information and sign prior to having your appointment.
Payments are due at the time services are rendered, unless prior arrangements have been made with our billing department. Co-payments and balances are due at the time services are rendered. We gladly accept cash, checks, and for your convenience all major credit cards. Returned checks will be subject to a $25.00 returned
Please ensure that we have a copy of your most current insurance card on file and that if any changes occur with your insurance we are notified promptly, this will ensure that we have acquired the proper authorization
required by your health care plan to continue your care. It is important that you understand we view your
insurance as a contract between you, your employer and the insurance company and that we cannot become
involved in disputes between you and your insurance company regarding deductibles, co-payments, covered
charges etc. Our services are rendered to you, not your insurance company.
We participate in many different health plans and accept assignment with Medicare. Not all services are a
covered benefit so be aware of your benefit package with your insurance company.
Any charges not paid by your insurance company are solely your responsibility. We file secondary insurances as a courtesy. If your secondary insurance fails to remit payment within 60 days, we require you to pay the remaining balance.
Patient statements are mailed monthly. Please pay promptly upon receiving your statement. All outstanding
balances older than 90 will be subject to review and forwarded to our collections agency where an additional
50% will be added to the outstanding balance. We understand that temporary financial problems may affect
timely payment. We encourage you to contact our billing department to make arrangements.
Again, thank you for choosing us for your health care needs, and we appreciate the opportunity to serve you.