Office Financial Policy


  • There will be a charge for all serviced performed by the doctor in the office and in the hospital.  By allowing the doctor to care for you, you are agreeing to pay for the services rendered and are responsible for payment in full.  For all office visits, you must pay for your care at the time of your visit.  We accept cash, check, Mastercard, Visa, Discover, American Express and Diners Club. There will be a $25 fee on all returned checks. 
  • Co-pays: Payment is required at the time of service.  If the physician performs two different procedures on the same day of service, your insurance company may require a co-pay on both services.
  • Referrals: Some HMO and managed care companies do not require a referral for a Preventative Annual Exam, but do require one if any medical problem is addressed during the visit.  It is your responsibility to obtain a referral from your Primary Care Physician (PCP) or you will be responsible for all non-covered services provided.
  • Procedures: Any procedures, which are performed either in office or off site, will be billed to your insurance company.  However, if there are any co-payments or deductibles, payment in full is due at the time of service.  If the procedure is not covered by your insurance, you will be responsible for payment in full.
  •  Minor: if you are under 18 years of age on your first visit, a parent or guardian that has the authority to make decisions regarding your treatment must accompany you.  For each subsequent visit, a written authorization by a parent or guardian for routine treatment is sufficient.
  • Surgery: If there are any co-pays or deductibles for surgeries to be performed, payment in full is due at least 3 days before the surgery date.
  • Appointment Cancellation Policy: Our policy requires at least 24 hours notice prior to the appointment time that is being cancelled.  We reserve the right to charge you a fee if we do not receive proper notification.  Please be aware that we will bill any charges associated with missed appointments directly to you, even if you have insurance coverage.  Insurance policies will not cover charges for cancelled or missed appointments.
  • We reserve the right to charge a fee for all patient records, etc. that are requested by the patient.
  • Payments may be applied to the oldest outstanding balance.  Please retain your receipts for your records.
  • In almost all cases, insurance payments are sent directly to the doctor.  If you receive a check for payment of services performed by the doctor, you must bring that check to the office and sign it over to pay your outstanding balance.
  • If payment is received by the office for services that has been paid in full, a credit balance will be applied to your account.  You may request a refund.
  • Any account balance not paid within 30 days will be subject to a service charge.






Contemporary Gynecology, P.C. Copyright 2017. All rights reserved