Financial Policy

We are committed to providing you with quality and affordable healthcare. Our fees are representative of the usual and customary charges for our area. 

Please review our financial policy and and ask us any questions you have.

Patient Financial Responsibility

• Please confirm with your insurance provider that Gorges Health is in-network prior to your first appointment. If you are seen and our practice is not recognized by your insurer, you will be financially responsible for the visit.
• Your insurance agreement determines your financial obligations, including copays, deductibles, and out-of-pocket limits. It is Gorges Health’s responsibility to bill and collect payment from you directly for the portion of your bill that your insurance does not cover. 
• All coverage questions should be directed to your insurance company.

Gorges Health Administrative Fee Policy:

$200 annually per patient

With the opening of Gorges Health, we are instituting an “Administrative Fee” for patients establishing primary care. While an “administrative fee” is something most patients have not heard of, it is becoming increasingly common to help cover the costs inherent in operating a private practice. It allows Gorges Health to provide the personal level of attention not attainable at a large medical practice. 

Many private practices charge an administrative fee annually. Gorges Health is still devising our administrative fee policy and will likely charge a smaller fee annually after the first year of care. The administrative fee can usually be paid for out of your Health Savings Account or Flex Spending Account.

Patients generally are unaware that primary care physicians spend several hours per day providing services that insurance does not pay for. These tasks are time consuming, occur outside of office visits and are essential to providing high quality primary care. They include but are not limited to the following:

• Phone calls and portal messaging with patients outside of an appointment time
• Reviewing data, such as imaging reports, lab results, specialist’s office notes, historical medical records, pharmacy and insurance correspondence
• Prior authorization completion for medications, imaging studies, surgeries and procedures 
• Completing forms and writing letters for patients or insurance companies
• Ordering additional tests in response to results
• Renewing medications outside of appointments
• Referring patients to specialists (including physical therapy referrals) which requires review of data, writing letters, and multiple additional steps
• Phone consultations with providers including radiologists, laboratories and specialists

Participation in the administrative fee policy is optional. You may choose instead to pay for services as needed. If you choose to forego the administrative fee, Gorges Health will bill you individually for medical services occurring outside of your appointment as noted below. Gorges Health will waive the administrative fee for patients who have Medicaid insurance plans, are self-pay, or have financial hardship.

A La Carte Pricing For Tasks Outside Your Appointment Time

1. After hours phone calls less than 10 minutes: $25

2. After hours phone calls equal to or greater than 10 minutes: $50

3. Prior Authorizations: $50

4. Sending medical records to other providers or individuals: $0.75 per page up to a maximum of $50

5. Form completion outside of office visits: $25

6. Referrals made outside of an office visit: $50.

Please note: New referrals typically require an office visit if the problem has not been previously evaluated.

Credit Card On File Policy

• Many patients have high deductible plans and are responsible for larger portions of their healthcare expenditures. For this reason, we require all patients to have an up to date credit card on file. 
• The portion of your bill not covered by insurance will be billed to your credit card. You will be notified of this charge via the portal 5 days prior to the card being charged.
  

Missed CoPay

• We are required to collect copayments at the time of your appointment.
• We can’t waive this payment due to the contract agreement with your insurance company. If you forget to pay your copay at the time of your appointment more than once, we may charge a missed copay fee of $10. 
• Enroll in our “Credit Card on File” program to avoid this fee, and keep your credit card on file for easy payments.
  

Account Balances

• We expect all patients to pay their bills in full within 30 days of receiving a statement from us. Please get in touch with our office to set up a payment plan if you need more time to pay the balance, or you can create your own payment plan via the portal. 
• 60 Days: A late fee of $25 may be accessed.
• 90 Days: Not allowed to schedule appointments until balance is paid.
• 120 Days: Will be reviewed for referral to a collections agency.
• Failure to pay an overdue balance on your account is cause for dismissal from Gorges Health.
• If you are unable to pay your bill please discuss this with us so we can work out a payment plan.
• Checks written with insufficient funds: a $50 fee will be charged to the patient for all returned checks.