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August 27th to October 29th
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Office Information: Financial Responsibilities

Lakeside Orthopedics is pleased to welcome you to our practice. Please become familiar with our financial policy:

• Our Physician-Patient relationship is with you not with your insurance company. Filing insurance claims is a courtesy that we extend to you, but it may be necessary for you to check with your insurance company about your benefits. You are responsible for any portion of any charges which your insurance company considers to be "Non-Covered" or "Patient Responsibility."


• For patient protection to prevent identity theft and theft of services, a Federal Law requires us to make a copy of your Drivers License or personal identification card (i.e. Government-Issued Photo ID) at EVERY visit. If you are the parent or guardian of a minor patient, we must make a copy of the patient's AND your identification at EVERY visit.


• You are required to present your insurance card at each visit. Failure to provide a valid insurance card may result in your classification as a "self pay" patient. The next paragraph is addressing the responsibilities of patient's who have no health insurance.


• "Self Pay" patients: If you have no health insurance coverage and are a NEW patient, a minimum down payment of $250 is required at the time of your first appointment. If you are an ESTABLISHED patient, a minimum down payment of $100 may be required at the time of every visit. Payment must be made with cash or credit card only. No checks allowed. You will be contacted by our Business Office to establish a formal payment plan for your remaining balance.


• Our office files all insurance claims. However, we may not be participating providers for all insurance plans. It is ultimately the patient's responsibility to ensure coverage at the time of service.


• We file all insurance claims. However, we may not be participating providers with your insurance plan. It is your responsibility to contact your insurance company to determine your coverage before your appointment. You are responsible for any portion of any charges which your insurance company considers to be "Non-Covered" or "Patient Responsibility."


• All co-payments are due on the date of service. If you are unable to pay your co-payment on the date of service, we may reschedule your appointment.


• If your insurance company requires a written referral, you are responsible for obtaining the referral from your Primary Care Physician before your date of service. If you do not receive the required written authorization before your date of service, it may be necessary to reschedule your appointment. If your insurance company allows, you may be able to sign a waiver accepting financial responsibility for the entire balance of that day's services according to the "self-pay" patients policy.


• If you believe that your current condition is a work-related illness or injury you will be required to present your personal insurance card in the event that the Worker's Compensation carrier denies your claim. If your personal insurance company requires a written referral, you must obtain a referral for all services in the event that the Worker's Compensation carrier denies your claim.


• After your insurance company has processed your claim, you will receive a statement showing the "Patient Responsibility" and "Non-covered" portion of your charges. Statements are mailed four times per month in alphabetical order groups.


• Any unpaid balances older than 30 days will be subject to collection activity. Collection activity includes but is not limited to an attempt to reach you by telephone and a final notification letter. If you fail to make arrangements for payment your account will be turned over to Professional Choice Recovery, Inc.


• Our goal is to help you understand your financial responsibility. If you have any questions prior to your visit after you have received the explanation of benefits from your insurance company or when you receive your statement, please do not hesitate to call our Business Office at 1-866-593-7510 during the hours of 8am-5pm, Monday through Friday.