FINANCIAL AGREEMENT:Financial Policies • February 19th, 2014
The patient is ultimately responsible for payment in full of their account, not the insurance company. We do, however, file dental insurance claims as a courtesy to our patients. We can only make estimates regarding your insurance benefits based on the information provided by you and the insurance company. In the event that your insurance company does not pay as much as expected, the remaining balance is due and payable immediately by you, the patient. INITIALS:
This is an agreement between Central Virginia OB/GYN and the responsible party:Financial Policies • November 13th, 2014
Missed/Cancelled Appointments, procedures or surgeries: All efforts are made to accommodate our patients request for appointments, procedures or surgery dates/times; therefore, it is important that you make every effort to keep your scheduled appointments. Cancellations of less than 24 hours or missed appointments will be subject to a fee up to $25.00. Cancellations of less than 7 days of procedures or surgeries are subject to a fee of up to $75.00
