BILLING POLICY
Patients who carry health insurance should remember that professional services are performed and charged to both you
and your insurance company. Please be familiar with your specific policy, what it covers and if you are required to have a
referral prior to your appointment. You should also be familiar with the participating providers for your plan including
laboratories and x-ray facilities as you are ultimately responsible for the entire bill.
1. Please bring your INSURANCE CARD and present it at the time of service. At the time of the visit, we require payment of any
unmet deductible, as well as the expected co-payment determined by the patient’s insurance carrier. New patients without
health insurance are required to pay half the total charge at the time of visit and the remaining balance within 30 days.
2. It is the responsibility of the patient or guardian of a patient to ensure that a REFERRAL is valid at the time services are
rendered. Certain insurances require members to obtain a referral form and/or number from their Primary Care Physician prior
to the visit. If the patient does not have a valid referral, they may not be seen. If a patient chooses to be seen without
referral, they will be asked to sign a waiver and will be responsible for payment at the time of service.
3. If we are not contracted with your particular insurance plan, we cannot accept responsibility for collection of your insurance
claim or negotiating a settlement on a disputed claim. We cannot wait for disputed or pending claims to pay. You are
responsible for payment in full on your account within the 45 day limit of our policy.
4. It is the responsibility of the patient or guardian to ensure that the account is paid within the terms of our 45 day policy.
There will be a $25.00 SERVICE CHARGE on all returned checks.
5. It is your responsibility to request an estimate for skin testing co-pays prior to your skin testing appointment. Please
familiarize yourself with the benefits of your specific plan.
6. Patients who are on a regular injection schedule are required to pay their account in full on a monthly basis. All other services
must be paid for at the time services are rendered.
7. Before allergy extract can be taken from this office, the patient’s share of the charge must be paid in full.
8. We require a minimum 24 hour notification when cancelling an appointment (except in case of an emergency), especially new
patient visits or visits involving skin testing or antibiotic testing due to their costly preparation. If 24 hour notice is not given,
we reserve the right to charge the full amount of a scheduled office visit.
***Please read our Cancellation Policy as you may incur additional charges if notifications are not made.***
9. Typically, we call 48 hours prior to your appointment to confirm that you will be coming. If we leave a message for you we
expect you to call back at least 24 hours before your appointment to confirm. We reserve a considerable block of time for
your appointment and it is difficult to fill this time slot with another patient with little or no cancellation notice. If we d not
hear from you within 24 hours prior to your appointment time, your appointment may be cancelled and you will be asked to
reschedule if you appear for your appointment without confirming first.
Patient/Guardian Signature:
Date:
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4901 Lang Avenue NE, Suite 100
Albuquerque NM 87109
(505) 883-2574