Contact us at 816.246.4302

Welcome to Rockhill Orthopaedic Specialists!

Thank you for choosing and entrusting us as your healthcare provider.
As a courtesy to our patients, it is our office policy to bill your insurance company for treatment provided, at the completion of each appointment. Please bring your current insurance card to each visit and notify our office if you have any changes to your insurance coverage.

REGARDING HMO’S, PPO’S and MANAGED CARE PROGRAMS-
We do not participate in some of these programs. Please check with your insurance company to see if we are providers of your plan. It is your
responsibility to obtain initial referral forms, etc. required by your particular insurance company, this also includes follow-up visits and visits to other physicians in our group. Please be aware that if you are seen out of network, you are liable for the difference in coverage benefits. Also,
some HMO/PPO/Managed Care Primary Care Physicians require all x-rays be taken at their office only, check with your physician before your
appointment.

CO-PAYS-
You will be expected to pay your co-pay prior to seeing your physician. For insurance plans that we contract with, your carrier requires that all
co-pays be paid prior to any services being rendered. The co-pay requirement cannot be waived by our practice, as it is a contractual
agreement between you and your insurance carrier. If you do not have your co-pay at the time of your visit, you will be required to reschedule
your appointment. You are responsible for any co-insurance, deductibles or non-covered services as required by your insurance. You will
receive a statement from our office indicating what your insurance has paid. Any remaining balance is due upon receipt of that statement.

REGARDING PATIENTS WITH NO INSURANCE-

(Auto, Third Party Liability or no medical coverage at all
Payment is due at time of service. We require a $400.00 deposit at time of service.)

REGARDING MEDICARE-
All of our providers are participating physicians with Medicare. We will file all charges (including x-rays, braces, and etc.) with your Medicare
and your supplemental insurance, if applicable. If you do not have a supplemental insurance, you will only be billed for the 20% not paid by
Medicare or any deductible that has not been met.

COMPLETION OF FORMS-(Disability, FMLA, etc.):
A charge will be assessed per form. Payment of $25.00 required before the form(s) will be completed for each form.

WORKERS’ COMPENSATION-
Our office requires authorization from your employer or your third-party administrator in order to schedule your initial visit.

MINOR PATIENTS-
If you are a minor your parents and/or guardian need to accompany you to our office before treatment can be rendered. You need to make
arrangements prior to being seen with your parent and/or guardian for payment to be made at the time of treatment. Our office is not at party
to your divorce decree, which means the financial responsibility for the minor rests with the accompanying adult.

X-RAY-
For your convenience, we do have x-ray facilities in the building. If x-rays are indicated in your treatment, charges are handled in the same
manner as the physician charges. If you have had x-rays taken somewhere else, please bring them with you to your appointment.

LAB-
In the event we need to have a lab drawn, our office uses an outside laboratory services. You will receive a separate bill for the lab services. It is
always your responsibility to see that your account is paid, regardless of insurance or any other circumstances (such as litigation). Patient is
responsible for costs associated with collecting said owed balances including but not limited to, collection agency fees, attorney fees, and court
costs.

IF YOU HAVE ANY QUESTION CONCERNING OUR BILLING POLICIES OR WE CAN ASSIST YOU IN ANY WAY, PLEASE FEEL FREE TO CALL ON OUR
PATIENT FINANCIAL COUNSELOR AT: 1-816-251-7249.