Financial Policy
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Financial Policy

Thank you for choosing Northwest Urology as your health care provider. As a specialist clinic, it is our policy that patients pay at the time of service for the minimum portion of their bill that is patient responsibility. Patients who are not prepared to pay may be required to reschedule their appointment. Patients may still receive a bill for in-house labs, pathology, procedures, additional services ordered during their appointment, if the appointment took longer than expected, if their insurance company adjusts the bill, or if new information is acquired bringing about new charges. These bills are non-negotiable.

If You Are Insured:

What an insurance company pays depends on their policies and the coverage purchased by the patient. It is the patient’s responsibility to review their coverage and plan exclusions with their insurance carrier prior to their appointment. Patients will be responsible to pay for their deductible, copay, coinsurance, or any denied services. If we are unable to verify your insurance, you will receive a statement for any charges accrued during that visit. In order for us to bill an insurance company, the patient must provide us with complete and current insurance information. However, regardless of coverage, the patient is still responsible for the balance of charges incurred. Not all services we provide are covered by every plan; those services that the insurance determined to not be covered will be your responsibility, i.e.: sexual dysfunction, infertility, circumcision, genetic testing.

Additional information for our pediatric patients, all current insurances must be provided, and the appropriate primary policy must be indicated. The primary policy is assigned by the parent’s date of birth unless there is a divorce decree. The responsible party for any supplemental payment must also be designated, as well as their current mailing address. 

For most services we do offer a Card on File option, for any deductible or coinsurance amount, if applicable, at the time of service. The remaining balance will be billed to your Visa, Discover, American Express, or MasterCard once your claim is processed by your insurance. The card on file option can’t be used for the following services: circumcision, urolift, rezum, injections, space oar, vasectomy, vasectomy reversal, infertility, co-pays, or any self-pay appointments.

If You Are Not Insured:

If you do not have insurance, are unable to provide proof of insurance in a timely manner or are on a plan that we do not participate in, full payment is due at the time of service. If you were not already notified, feel free to contact us in advance to receive the estimated amount due for your appointment. “As a courtesy for paying in full at time of service, you will receive a 20% discount for services rendered. Please be advised, this discount applies to professional services rendered by our provider and does not apply to drug costs.”

For All Patients:

  • For estimates provided it may not include physician, outside lab/pathology, anesthesiologist, radiologist, and other specialist professional fees.
  • Any estimate provided does not guarantee your health insurance plan coverage, benefits, service authorization, or payments.
  • Your final bill will vary based on possible changes in service(s), medical conditions, final diagnosis, complications, your health insurance plan benefits at the time of the service(s), and the eligibility and coverage determined by your health insurance carrier.
  • I understand and acknowledge that bodily fluids or tissues collected by Northwest Urology, LLC will be sent to an unaffiliated lab and that I will receive a separate bill from them for test and interpretations.
  • Missed appointments or cancellations made with less than 24-hour notice may incur a $75.00 fee. This fee may also be assessed if a patient is more than 15 minutes late for their appointment. If the physician is delayed in the operating room or running behind in the clinic, a patient is welcome to reschedule his/her appointment. If no shows or late cancellation behavior continues you could be discharged from the practice.
  • A fee of $25.00 will be charged for the completion of paperwork or forms i.e., some examples: FMLA, workers comp forms, disability paperwork, insurance paperwork, or medical leave. After payment we will have the form completed within 10 business days.
  • Each returned check for stop payment or non-sufficient funds (NSF) will generate a $40 fee.
  • Medical records can be downloaded instantly, and free of charge, on our portal at www.nwurology.com. Printed record requests containing 10 pages or less can be provided for a $30 fee, and $0.25 for each additional page. An additional charge of $5 will be applied for records requests processed within 7 business days. A signed authorization from the patient may be required to release information.
  • Accounts with balances exceeding 90 days that are released to a collection agency incur a late fee of $35.
  • Additional payment options may be applied for by calling our billing office prior to your visit at 971-244-0798.

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