HILLTOP MEDICAL CLINIC/ HILLTOP MEDICAL CLINIC WEST offers primary and some secondary insurance billing as a courtesy to our patients.
Our policies are as follows:
- We will bill your primary insurance and some secondary insurance companies.
- Services performed outside of HTMC will bill you separately.
- HTMC does not bill third party claims (motor vehicle accidents, injuries sustained while shopping, homeowners liability claims, etc.). Payment is expected at the time of service and a billing/receipt will be issued to you for billing purposes.
- Insurance co-payments and deductible amounts are required at the time of service.
- Billing insurance does not relieve you of the responsibility for your bill.
- You will receive monthly statements so you will be aware of any outstanding balance on your account.
- We allow 60 days from the date of service for ALL insurance s to respond. Thereafter, you will be expected to pay the balance.
- Patients discovered to not have insurance or those with deductibles are expected to pay the balance immediately. You cannot be seen at either Clinic until the debt is paid.
- Hilltop Medical Clinic / Hilltop Medical Clinic West charges a $20.00 fee for any returned check or
declined POST DATED credit card.
- Statements are mailed monthly.
- Our office cannot follow up on all delinquent insurance claims. Please call your insurance company and check on the status of the claim.
AUTHORIZATION TO RELEASE INFORMATION: I hereby authorize Hilltop Medical / Hilltop Medical Clinic West to furnish my insurance company(ies), and/or their Attorney or an Industrial Related Injury insurance company, and/or their Attorney or collection agency, with any and all information which said parties may request or be provided with, concerning my office visits here.
WAIVER OF CONFIDENTIALITY: If the account is submitted to an attorney or collection agency, goes to court or is reported to a credit reporting agency, the fact that you received treatment here may become a matter of public record.
ASSIGNMENT OF BENEFITS: I hereby assign Hilltop Medical / Hilltop Medical West all money to which I am entitled for medical and/or surgical expense related to the services reported herein, but not to exceed my indebtedness to Hilltop Medical Clinic / Hilltop Medical Clinic West. It is understood that any money received from the insurance company(ies) over and above my debt will be refunded to me, or back to my insurance company, when my bill is paid in full. I understand that I am financially responsible to Hilltop Medical / Hilltop Medical West for charges not covered by this assignment.