Your First Visit
Please bring in the items below at the time of your first visit:
1. Your insurance identification card so that we may copy the front and back of the card for accurate insurance information.
2. Your drivers license so that we may copy the card for accurate demographic and patient specific data.
3. If you have a health plan that requires its own insurance claim form, please provide us with a signed and completed claim form.
4. Your referral or authorization for services, if applicable.
All co-payments, coinsurances and deductibles are expected to be paid in full at the time of services. If you do not have insurance, all amounts due for services rendered must be paid in full at the time of services.
For your convenience Fabrizio Physical Therapy & Sports Medicine, Inc. accepts the following forms of payment:
• Master Card
• American Express
Please note that in the event of non-payment, the account may be placed with an outside collection agency, and the expenses will be added to your account balance. Balances that exceed 30 days from the date of service may be charged a finance fee of 1.5% per month.
If you have any questions, please feel free to ask one of our representatives or our billing service.
If you do not have a valid insurance plan to cover the cost of our services, you will be required to make full payment at the time of service.
If you are insured, we will bill those insurance plans with which we have an agreement. However, it is ultimately your responsibility to become familiar with the details of your insurance plan coverage. We recommend you contact your insurance company prior to any service so you may understand your allowable benefits. If you have a PPO insurance plan, we will collect the required co-payment, co-insurance, and any deductible that is due at the time of the visit. In the event that your health plan determines a service to be “non-covered,” we will bill you, and payment is due upon receipt of that statement. Any amount not paid by your insurance company within 30 days will be billed to you. We are currently contracted with Blue Shield of California and Medicare. We do not accept HMO/Medicaid plans.
If your insurance coverage is with a plan that we do not have an agreement, payment is expected in full at the time of service. As a courtesy, we will submit a claim to your insurance company on your behalf.
(Some plans will be accepted depending on reimbursement).
Third-Party Liability Injuries
For patients who have been involved in a liability/third-party accident, payment in full is expected at the time of service.