Financial Policy for Patient Care Services
Account Information



Financial Policy for Patient Care Services

To help us provide the most efficient and reasonable health care services, it is necessary for Tri Valley Urology to have a Financial Policy stating our requirements for payment of services provided to our patients. Patients are responsible for the payment of all services provided by our office. It is our policy to bill your insurance as a courtesy to you if we have accurate and complete insurance information. The balance due is still your responsibility if we have not received payment from the insurance company within 30 days. If we receive duplicate payment from the insurance company, we will then prepare a refund for any overpayment and send it to you.

If you have insurance and we file with your carrier, we ask you pay ahead of time on the balance which is your responsibility according to your plan, (i.e. any deductible, co-pay, coinsurance amounts). For Medicare patients, we will wait until we have received payment and then bill the patient for any remaining balance due. Since we are not a party to the agreement between you and your insurance company, we ask that you assist us in contacting them in the event that services are not paid within 45 days.

If you do not have insurance and are not covered by Medicare, you will be considered a “Self Pay” patient. Payment is due in full at the time of service. This assists us in cutting down on billing and operating expenses.

Patient "No Shows" or last minute cancellations are disruptive to our practice and a tremendous loss. Please help our office reduce those losses by cancelling within 24 hours if you cannot keep your appointment. Failure to give notice 24 hours prior to your appointment will result in a $25 fee to be paid by the patient.

We ask that you read this policy and aid us in keeping our costs down by ensuring that we are able to be reimbursed for our services on a timely basis. We welcome the opportunity to discuss any aspects of our financial policy.

To help in this policy we ask that you assist by

  • Providing us with current and updated information on yourself and your insurance company and to keep all changes up to date.
  • Make payments at the time of services for the entire balance if you are a “Self Pay” patient or the amount of any deductible, co-pays that may be due.
  • Discuss your account balance only with the check-out or billing staff. Please do not discuss the financial aspects of your care with the physician(s). It is important for them to be allowed to practice medicine and provide patient care. Please work with the rest of the office staff on any account questions or problems you may have. If they cannot help you or answer your questions to your satisfaction, then please, do not hesitate to contact the office manager.