Financial & Appointment Policy

Financial Policy:  Payments & Insurance

Payment is required at the time services are rendered including applicable deductibles, coinsurance, and co-payments.  We accept cash, VISA, MasterCard, Discover and personal checks (there is a $40 service charge for returned checks).  If you are unable to pay your co-pay at the time of service, your appointment will be rescheduled as this is a breach of our and your contract with the insurance company.  Please do not expect to be seen if you are unable to meet your financial obligations.

Patients with an outstanding balance 60 days or more overdue must make arrangements for payment prior to scheduling appointments.  If it becomes necessary to forward your account to a collection agency or attorney for the purpose of collection, in addition to the amount owed, you will be responsible for any fees charged by the collection agency and/or attorney.

You are responsible for providing us with current and accurate insurance information.  We will bill your insurance company for all services provided.  You are expected to pay your deductible, coinsurance and co-payment at the time of service.  We will estimate the amount you owe at the time of service based on the information we receive when verifying your insurance coverage; however, it is ultimately your responsibility to know your coverage.  You are responsible for all charges not covered and/or paid by your insurance.  If there is a conflict with your insurance regarding coverage, including primary or secondary insurance eligibility, it is your responsibility to resolve this conflict.  If not resolved in the time frame allowed by your insurance company to submit claims, you may no longer be allowed to appoint in our office.  If you need assistance or have questions regarding your insurance coverage or account balance, you may contact our office at (601) 798-0500.

Appointment Policy:  Missed Appointments, Late Arrivals, Late Cancellations & Confirmations

Missed appointments represent a cost to us, and an inconvenience to other patients who could have been seen in the time set aside for you.  Cancellations are requested 24 hours prior to the appointment.  We reserve the right to charge for missed or late-cancelled appointments.  If you have a series of appointments scheduled and fail to show up for any one of these appointments without calling to cancel or reschedule with proper notice, all remaining appointments will be cancelled for you and any family members that may also be scheduled.

A failed appointment occurs for any of the following reasons:

  • The patient or patient’s parent/legal guardian does not provide at least 24 hours notice of cancellation;
  • The patient does not show up for a scheduled appointment; or
  • The patient arrives more than 5 minutes after the scheduled time of the appointment, requiring the appointment to be rescheduled. 

Excessive missed appointments or late cancellations may result in discharge from the practice for the patient and all family members.  By signing this form, you understand that if you or any member of your family, individually or collectively, have three or more failed appointments that you may no longer be allowed to appoint in the future. 

Our office confirms appointments on the business day prior to the scheduled appointment.  It is your responsibility to maintain current contact information.  If we are unable to confirm an appointment that is scheduled more than 14 days in advance of the visit, we reserve the right to cancel the appointment without notice to the patient.