Healthcare Collection Policy

HEALTHCARE COLLECTION POLICY

Patient Information

Insurance Information

Medical Background (for billing context)

Policy Scope and Purpose

This Healthcare Collection Policy establishes the practice's procedures for billing, internal collection efforts, assignment to third-party collection agencies, reporting of delinquent accounts, and handling of patient disputes and financial hardship requests. The policy applies to all balances for professional and facility charges not fully paid by the responsible party or third-party payors.

Billing and Statements

Statements are issued to the guarantor at regular intervals. If a balance remains unpaid after days from initial statement, the account will be subject to intensified collection activity, which may include additional statements, telephone outreach, and written notices.

Patients have the right to request an itemized bill and to submit a dispute in writing within days of receipt of a statement. Disputes will be acknowledged in writing and investigated promptly.

Patient Financial Responsibility

The patient or responsible party is ultimately responsible for charges for services rendered. The practice will bill primary and secondary insurers on the patient's behalf when insurance information is provided. Any remaining balance not covered by insurance is the responsibility of the patient. The practice may assess reasonable administrative fees or interest where permitted by law.

Financial Assistance and Hardship

Patients may apply for financial assistance or a hardship arrangement. The practice will evaluate applications in a consistent, nondiscriminatory manner. While an application is pending and complete, the account will be placed on hold for collection referral.

Third-Party Collections and Credit Reporting

Accounts unresolved after internal collection efforts may be assigned to a third-party collection agency or referred for legal action. Assignment may result in additional collection fees and reporting of the delinquent account to consumer reporting agencies where permitted by law. Before assignment, patients will receive notice of intent to refer for collection and an opportunity to contact the practice to resolve the balance.

Communications, Privacy and HIPAA

The practice will protect patient health information in accordance with applicable privacy laws. Communications related to billing and collection may include protected health information necessary to collect payment. By signing below, the patient acknowledges receipt of the practice's privacy notice and authorizes communication as indicated above. The practice will limit disclosed information to the minimum necessary for collection purposes.

Dispute Resolution and Appeals

To dispute a charge, the patient must submit a written description of the dispute within the time period specified above. The practice will provide an itemized explanation and respond in writing. If the dispute is not resolved, the practice will inform the patient of the right to appeal and any available internal complaint processes.

Refunds and Overpayments

Refunds for overpayments will be issued in accordance with applicable law and practice procedures. Patients should notify billing promptly of suspected overpayments and provide documentation where available.

Record Retention and Confidentiality

Billing and collection records will be retained in accordance with applicable law and practice policy. Access to billing records will be limited to authorized staff and third parties as necessary for collection or audit purposes.

Acknowledgment and Authorization

I acknowledge that I have read and understand this Healthcare Collection Policy. I accept financial responsibility for services rendered and authorize the release of any information necessary to process claims or to collect payment. I understand that failure to resolve outstanding balances may result in referral to a collection agency and/or reporting to credit agencies where permitted by law.

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