Wichita, KS Family Care | Call (316) 202-9732 | 9415 E Harry St, Suite 202, Wichita, KS 67207
To Make an Appointment Please Call 1-316-202-9732

Payment Policy at Primary Care Clinic in Wichita, KS

We appreciate your visit and are committed to providing you with quality health care. Please understand that payment of your bill is part of your care. Insurance. We participate in most insurance plans, including Medicaid and Medicare. We Expect You knowing your insurance benefit. It is your responsibility to make sure the correct in-network facility is used for all test and hospital encounters. Please contact your insurance company with any questions.Co-payments. All co-payments should be paid at the time of service. Failure to collect co-payments and deductibles from patients is considered fraud. Please help us in upholding the law by paying your co-payment at each visit.Payment. We accept cash, check, VISA, MasterCard, Discover or American Express. All previous balances must be paid at time of service, unless prior arrangements have been made with the billing department. If a check is returned for insufficient funds or payment has been stopped, you will be charged a $25 fee in addition to the amount of the check. If you have a second check returned, you will be asked to pay by cash, money order, cashier’s check, or credit card for future visits.

Self-Pay. A minimum $65 payment for existing patients and $85 for new patients is due prior to treatment from all uninsured patients.

Co-insurance and deductibles. Your co-insurance and/or deductible balance is due when you receive your explanation of benefits from your insurance company.

Minor Patients. Guardians/Parents are responsible for payment of all minor patient payments and balances. Sports, camp, and work physicals are not covered by many insurance companies. “Sports Physicals” should not replace the annual well-child exam. We can complete a clearance form at the time of your child’s well-child exam. We recommend a sports physical be provided in the context of a full preventive visit.

Proof of insurance. All patients must complete our patient information form periodically prior to seeing the doctor. We must obtain a copy of your driver’s license, your current insurance card and your social security number in order to confirm proof of insurance and file your claim.

Coverage changes. If your insurance changes, please notify us before your next visit so we can make the appropriate changes to help you receive your maximum benefits. If your insurance company does not pay your claim in a timely manner, the balance will be your responsibility.

Missed appointments. Our policy is to charge for missed appointments not cancelled within 24 hours prior to your appointment. There will be a $25 charge after the third missed appointment. These charges will be your responsibility and billed directly to you.

Nonpayment. If your account becomes delinquent, you agree to pay any charges to collect your unpaid bills, including but not limited to, reasonable court costs, and/or collection agency fees.You must contact us for a reasonable payment arrangement or risk collection action. Please be aware that if a balance remains unpaid, we may refer your account to a collection agency or a collection attorney and you and your immediate family members may be discharged from this practice. During that 30-day period, our physician will only be able to treat you on an emergency basis.

Worker’s Compensation or Motor Vehicle Accidents: It is your responsibility to file a report with your employer or automobile insurance. If you are injured on the job, please let the receptionist know so we may contact your employer to facilitate filing your claim. If you are injured in a motor vehicle accident, please bring your auto-mobile insurance card. Until your MVA claim is settled, you will be held responsible for your charges. We will be happy to refund any money received from your auto insurance carrier.

Referrals: If you have insurance that requires a referral, you must have your referral prior to receiving treatment. It is your responsibility to obtain all necessary referrals from your primary care physician. Patients without proper referrals who elect to receive service from the office will be required to make payments in full at the time of service.

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9415 E Harry St, Suite 202,
Wichita, KS 67207

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