IMPORTANT POLICIES

PATIENT FINANCIAL POLICY

It is the goal of Mount Rainier Urology to provide the best care on your behalf. It is also our desire to assist you in the financial arrangements related to your care. Therefore it is important for you to fully understand our insurance, credit and collections policies. Please read following information carefully and feel free to ask any questions your may have.

Upon registration, each patient is asked to complete certain new patient paperwork. A copy of your primary and secondary insurance cards and a valid picture ID will be requested for accuracy on insurance billing and confirmation of information.

  1. Referrals and Insurance Authorization are necessary if you are covered under a Medicare Advantage Plan, ie, AARP Medicare Complete, Premera Med Advantage, SoundPath, etc., and Tricare. We make every effort to have the referrals from your Primary Care Physician, however, if you do not have the necessary authorizations, we may not be able to see you at the time of your scheduled visit, unless you choose to waive your insurance coverage for that visit, assume
    financial responsibility for the full balance of your account and make payment at the time of service.
  2. Payment terms: Depending on your insurance policy benefits, you may be responsible for co-payments, co-insurance, deductible, or the entire portion for our services. Any patient portion of services is due in full at the time of service. If unusual circumstances should make it impossible for you to meet these terms, we invite you to discuss options available to you. We will work with you to arrive at a mutually acceptable payment plan, if warranted. We accept cash, checks
    and credit cards including Visa, MasterCard and Discover cards.
  3. No insurance: If you do not have health insurance coverage, we offer a 20% discount when payment is made in full at the time of service.
  4. Services for impotence, infertility and erectile dysfunction are rarely covered by commercial insurance plans. You should contact your health insurance plan to determine your benefits. If this is not covered, payment in full is due at the time of service.
  5. You will receive regular statements from our office informing you of the status of your balance. Feel free to call our office should you have any questions. All balances are due upon receipt of our statement. If we have not received payment in full after 90 days from the date of service, we reserve the right to refer your account to an outside collection agency where you will be responsible for any collection and/or legal fees incurred for the collection of your account.
  6. There is also a $40.00 fee for all returned checks that are processed through our office.
  7. Any hospital, lab, imaging (radiology), cytology or other ancillary services will be billed to you separately by another entity.

PLEASE NOTE THAT REGARDLESS OF INSURANCE COVERAGE, YOU ARE ULTIMATELY RESPONSIBLE FOR PAYMENT OF ALL SERVICES RENDERED.

Thank you for choosing Mount Rainier Urology. If you have any questions, please contact us at 360-350-0281.

Notice of Private Practices Acknowledgement

We keep a record of the health care services we provide our patients. The record is compiled by us and is our property, but you may also fill out a release of information request to receive a copy of it. We will need two weeks advance notice and a written release to make a copy for you. You may also ask to correct any factual mistakes you believe to be in the record once you reviewed it. We will not disclose your record to others unless you direct us to do so in writing or unless the law authorizes or compels us to do so. You may obtain further information about these matters by contacting our Privacy Office at (360)-350-0281.What topics do you think you’ll write about?

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Our Notice of Privacy Practices brochure describes in more detail how your health information may be used and disclosed, and how you can access your information. Please inform the Front Desk Receptionist if you would like a copy of the brochure.

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