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Chehalis Children's Clinic has developed a Financial Policy that clearly outlines patient and practice financial responsibilities. We are committed to providing our patients with the best possible medical care and also minimizing administrative costs. This Financial Policy had been established with these objectives in mind, and to avoid any misunderstanding or disagreement concerning payment for professional services.

1. Our office participates with numerous insurance companies and managed health care programs. For patients that
are members of one of these plans our business office will submit a claim for services rendered. All necessary insur-
ance information, including special forms, must be completed by the patient/patient's guardian prior to leaving the
office. If a patient has insurance that we do not participate in, our office is happy to file the claim upon request;
however, payment in full is expected at time of service.
2. It is the patient/patient's guardian responsibility to pay and deductible, co-payment or and portion of the charges as
specified by the plan at the time of visit. Any medical services not covered by an individual's insurance plan are the
patient's responsibility and payment in full is due at the time of visit. If this is not possible, we will be happy to resched-
ule your appointment. Payment for professional services can be made with cash or check.
3. Patients that do not have insurance are expected to pay for professional services at time of service unless prior
arrangements have been made with us.
4. It is the patient/patient guardians responsibility to provide us with current insurance information and to bring their
insurance card to each visit. In addition we require patient guardian's social security number and/or a government
issued ID.
5. Our staff is happy to help with insurance questions relating to how a claim was filed, or regarding any additional
information the carrier might need to process the claim. Specific coverage issues, however, can only be addressed by
the insurance company member services department (number is on the card).
6. For unaccompanied minors, non-emergent treatment will be denied unless charges have been pre-authorized or
payment by cash or check at time of service has been verified.
7. Unpaid balances are subject to a 1.5% per month service charge. A $30.00 charge will be assessed for all returned
checks or accounts referred for collections.
8. Our practice firmly believes that a good physician/patient relationship is based upon understanding and good com-
munication. Questions about financial arrangements should be directed to the billing office. We are here to help you.