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ARROYO MEDICAL GROUP, INC. FINANCIAL INFORMATION

This information is to help you understand your financial obligation to your physician.

GENERAL INFORMATION
  • Arroyo Medical Group, Inc., will accept cash, personal checks, MasterCard or Visa.
  • Current Insurance and identification cards are required.  If there are any changes to your insurance, please present your new card at the time of appointment.
  • We do do not bill tertiary (3rd) insurances.
  • Arroyo Medical Group, Inc. encourages you to become familiar with your health insurance plan and its benefits.  Any balance unpaid by your insurance company is your responsibility.
  • To protect you from impostors, your photo will be taken and kept on file at AMG.
  • We will suggest specialists based on medical necessity in our opinion.  It is your responsibility to find labs and specialists that will accept your insurance.  Please call your insurance company or the specialist to whom we refer you with any questions about coverage.

CO-PAYMENTS, CO-INSURANCE, AND DEDUCTIBLES:
  • CO-PAY: Co-payments will be collected at the time of your visit.
  • CO-INSURANCE: If we know what your co-insurance amount will be at the time of your visit, we will collect the amount at that time.  Otherwise, you will be required to pay your co-insurance within fifteen days of receiving your statement from our office.
  • DEDUCTIBLES: If you have not met your deductible when your medical services are provided, you will be expected to pay your deductible at the time of service.

SELF-PAY
  • If you do not have healthcare insurance, payment will be collected at the time of service.
  • In some cases, you may make arrangements with our Business Office to make payments.  Please contact the Business Office to make arrangements.

MEDICARE
  • If you are a Medicare beneficiary with Part B insurance, we will file your claim with Medicare.
  • Payments for services not covered by Medicare will be collected at the time of your visit.

NON-CONTRACTED PLANS
  • If you are covered by an insurance company that we are not contracted with, and wish to schedule with our physicians, payment will be collected in full at the time of service.  We will bill your insurance company as a courtesy, and the insurance company may reimburse you directly.

NON-COVERED BENEFITS
  • Certain professional services may not be covered by health plans and are billed at a cash rate.  The following are samples of non-covered services and prices.  Please ask in advance about your specific form, letter, or service for a quote of the cost to complete it:











These charges are in addition to any evaluation by a physician

AUTO ACCIDENTS AND PERSONAL INJURIES
  • If your problem is due to an auto accident or other injury, please let us know immediately so that the correct insurance information can be generated for you.  Since your injuries may involve different insurance companies with whom we are not providers, payments for medical care in our office are due at the time services are rendered.  We will send in an insurance claim for you, and your insurance company will reimburse you directly.
  • For a fee of $.25 per page, we can provide you with the copies of reports and paperwork required.
  • We do not accept liens.
  • If you prefer to see a different physician for your auto accident or personal injury claim, we will still see you for other medical needs.

WORKER'S COMPENSATION
  • Workman's Compensation is defined as any condition which results from or is aggravated by your job.  Your regular insurance does not cover this condition.
  • Our practice does not provide care for Worker's Compensation cases.  Ask your employer for a referral to a Worker's Compensation clinic.

PREVENTIVE HEALTH EXAMS
  • Routine physicals, annual exams and check-ups are examples of preventive health and will be categorized as such on any claims submitted to your health plan.
  • Many plans, including Medicare, do not cover preventive exams.  If you are concerned about coverage for an upcoming exam, please contact your health plan.
  • Claims will not be altered in any way once they are filed and verified to be accurate.  You will be responsible for any charges not covered by your health plan.

MISSED APPOINTMENTS AND LATE CANCELLATIONS
  • Though our office attempts to contact patients to confirm upcoming appointments, it is the patient's responsibility to manage his/her schedule and to keep appointments.
  • If you need to cancel or reschedule, please contact us at least 24 hours before your scheduled appointment.
  • If a patient fails to keep an appointment without giving notice, their account will be billed $35.00.

DELINQUENT ACCOUNTS
  • If a patient balance remains unpaid for 60 days, patients will receive a notice from our business office.  If the balance continues to go unpaid and no arrangements are made to make payments, the account will be sent to a collection agency.

RETURNED CHECKS
  • Any returned check will result in a $25.00 service fee.  Returned checks must be redeemed with cash or credit card within 14 days of being returned or the account will be considered delinquent.
  • Two returned checks within a 12 month period will place a patient's account on a cash-only status.
  • If we receive a check from a closed account, we will submit it to the District Attorney's office.



Physical Forms
School Medication Forms
Letters (any reason)
DMV Handicapped Placard
DMV Long Forms
Assisted Living Forms
Work Related Forms
Lost Prescriptions

$25 and up
$25 and up
$25 and up
$25 and up
$50 and up
$50 and up
$50 and up
$10 per medicine
Jury Duty Excuses
Original Disability Forms
Continuation of Disability Forms
Conservatorship Forms
Original Board and Care Forms
Insurance Sickness Claim Forms
Life Insurance Forms
Lost Prescriptions (Schedule II)
Prices are subject to change
$25 and up
$50 and up
$25 and up
$100 and up
$50 and up
$25 and up
$50 and up
$12 per medicine