Patient Financial Policy
Thank you for choosing DeKalb Clinic Chartered for your healthcare services. It is a pleasure to serve you. We are committed to providing the best medical care possible. The payment of your bill is an important part of providing quality services to our community. Please read and retain this Financial Policy.
Billing & Payment Procedures
At the time of registration, and periodically thereafter, you will be asked to complete a Registration Form to help keep personal and insurance information accurate.
You will be asked to present your insurance card or recipient card for Illinois Public Aid Benefits, and your driver's license or state identification card when you check in for each appointment. This process helps maintain correct insurance billing records.
Payment is required at the time of service unless other payment arrangements are approved in writing in advance of services to you and your minor children. If you have insurance benefits, all applicable co-pays and non-covered charges must be paid at the time of service.
Payment may be by cash, check, money order, and most major credit cards. Returned checks are subject to a service charge, and we reserve the right to request future payment by cash, credit card or certified funds.
First Patient Visit
A New Patient Payment is due at the time of your first appointment. The only patients exempt from the New Patient Payment are patients covered under a health insurance plan designating DeKalb Clinic as an in-network provider. The New Patient Payment will be credited to any amounts due on your account after processing insurance benefits. In the event that multiple family members have a new patient appointment on the same date, a maximum of two New Patient Payments will be assessed, to be equally credited to the account of each family member treated on the same date.
Primary Insurance Benefits
As a service to you, we will bill your insurance company. All co-pays, deductibles and non-covered charges are due at the time of service. It is your responsibility to determine whether DeKalb Clinic is an in-network or out-of-network provider under your insurance plan. Out-of-network claims may be paid less insurance benefits, require payment of a higher deductible amount, and/or require a larger patient payment. You are financially responsible for all charges not paid under your insurance plan.
Secondary Insurance
We will bill your secondary and, if applicable, tertiary insurance. If we do not receive payment on a secondary claim within 60 days of billing, we will expect payment from you. We encourage you to contact your insurance company to inquire about delays in the payment of claims.
Usual and Customary Charges
If your insurance plan denies full payment of your claim on the basis that certain charges exceed the "usual and customary" charge, please understand that your insurance company has determined that the charge exceeds the amount your health plan pays under your insurance contract. Although we are committed to providing quality care at fees that are reasonable and customary in our region or service, you are responsible for any billed amounts that exceed your insurance plan's Usual and Customary amount.
Assignment of Benefits
We require an assignment of insurance benefits on all insurance plans designating DeKalb Clinic as your provider. In the event that any insurance plan issues payment to your instead of DeKalb Clinic, you will immediately endorse and direct such payments to DeKalb Clinic for credit to your account.
Payment Plans
We understand that healthcare expenses may be a financial burden. We are willing to work with you to establish a reasonable payment plan upon full disclosure of your financial circumstances. DeKalb Clinic will document approved payment plans in writing to facilitate enforcement as agreed.
Missed Appointments
Please provide 24 hours notice if you will be unable to keep your scheduled appointment. Your notice allows us to schedule other patients requiring medical attention. We reserve the right to assess a missed appointment charge as policy allows. We reserve the right to end the physician-patient relationship if you continue to miss your appointments.
Late Charges
A late charge of 1.5% (18% annually) will be assessed on patient-due balances not paid in full 90 days after first billing. Past due accounts may be referred to a collection agency or attorney. You are responsible for all late charges, costs of collection, and reasonable attorney fees that we incur in collecting your past due account.
Other Medical Services
If you have lab tests, pathology or radiology services, or treatment in the Emergency Room or Hospital, you may receive a separate bill for fees incurred in addition to our bill for professional services.
Questions?
Please direct questions to our Patient Accounting Department, (815) 758-8671 Ext. 3640.
