The Southeastern Spine Institute

Patients are responsible for the payment of all services provided by the Southeastern Spine Institute.  After your visit, if the physician decides that further services are needed such as a procedure or surgery, we will call your insurance company to verify coverage. Our Physicians will not discuss payment with you. Please do not discuss financial issues with them.

Copays, coinsurance or deductibles must be paid prior to services rendered. For any unpaid balances, we send three statements, after which we may turn your account over to our attorney or collections agency.

Uninsured or self pay patients may be required to make payment at the time of service or prior to the provision of any procedures. However, a financial counselor will discuss with you ways you can meet your obligation.

Workers Compensation: 

If your case is authorized by your employer/workers compensation carrier, we will bill the carrier.

Pending Workers Compensation: 

If your case is pending authorization, we will file your health insurance, and we will require you to sign a subrogation form. Motor

Vehicle Accident or other Liability: 

If you are the victim of an accident and are filing claims against a third party, you may file a claim with your health insurance or pursue the third party on the advice of your attorney. If you do not have an attorney, and you do not have health insurance, we may ask you to review your circumstances with one of our financial counselors before your first appointment. If you choose to use your health insurance, we require you to sign a subrogation form, and pay all copays, deductibles, and coinsurance amounts at the time of or prior to service. If you sign a waiver providing that we be paid from funds at settlement, no payment is required at the time of service. However, we reserve the right to file a claim with your health insurance, based on our attorney’s recommendation.

Special Note to Medicare and Medicaid beneficiaries: 

If your illness is a result of or benefits are payable by a third party , Medicare and Federal regulations require us to attempt to collect our fees from the third party. Medicare and Medicaid are always the payor of last resort.

I understand the above financial policy and my responsibility.