ALFA MEDICAL CLINIC © 2011. All Rights Reserved. Site designed by The Branding Effect
2540 W Arrowood Road
Suite 110
Charlotte, NC 28273
Tel: 704.588.9997
Financial Policy
Welcome and thank you for choosing Alfa Medical Clinic, PA for your medical care. We are committed to providing you with the highest quality medical care possible.
- Payment in full is due at the time services are rendered. As a courtesy to our patients, we accept cash, personal check (w/Valid Drivers License), money order, Visa card, Mastercard and American Express card.
- We also provide you the ability to pay for your bills by phone by calling (704) 588-9997.
- Any amount not covered by your insurance is due from you within 30 days of the time of service.
- Failure to pay account balance will result in collection procedures and eventually, discharge from the practice.
In order to achieve our goal of providing you with the best care possible, we need your assistance and your understanding of our financial policy. We will be pleased to discuss with you any questions you may have concerning your bill.
Things to bring with you to EACH appointment:
- Health Insurance Card(s)
- Drivers License
- Method of Payment for Co-pays, Co-insurance, Deductibles and any other balances on account that are due before service will be rendered.
“Self Pay” Patients
- We offer a reasonable discount for our self pay patients. We will give you an estimate of your bill before services are rendered and payment for services is due at the time of service. Please see the receptionist for the estimate.
- Self pay patients will not be billed for their service since all services must be pay for in full at the time of service.
Medicare/Medicaid Patients:
- Please make sure you have a full understanding of your benefits and what might be your responsibility, if not covered by your insurance plan.
- Medicare requires that we provide patients with a written notification whenever it is likely that you will be responsible for a bill. Please ask our staff for a brochure that will help you understand your benefits.
Additional Paperwork:
- Any paperwork needed to be filled out by the physician will result in either a $10 to $25 charge, depending on the length of the paperwork.
- 7 days are required for all paperwork.
Missed or Canceled Appointments and other fees:
- If you are more than 20 minutes late for an appointment, you will be marked as a No Show. Failure to show for your appointment will result in a $25 fee.
- 24 hours notice is required to cancel all appointments.
- There will be a fee of $25 for any returned checks.
- All balances are due prior to any further service provided by our office.