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-OFFICE POLICIESANDERSON MEDICAL GROUPNORAH BAKER, MD AND GARY STEINMANN, PAC10 PROFESSIONAL PARK DR., MARYVILLE, IL 62062618-288-7244We would like to thank you for choosing the office of Norah Baker, MD and Gary Steinmann, PA-C to serve your primary care needs. As one of our patients, we would like to keep you informed on our current office and financial policies. We require that you read and sign this document and keep this document for future references.Missed Appointments- Patients will be responsible for a $50.00 Missed Appointment Fee for failure to notify the office of appointment cancellation at least 24 hours in advance. Termination of provider and patient relationship will result after the third occurrence. Reminder calls are completed prior to appointments as a courtesy. However, these calls are not mandatory and it is ultimately the patient’s responsibility to keep track of scheduled appointments. Late Appointments- If you are greater than 15 minutes late for your appointment you will be asked to reschedule. Insurance Cards & ID- Insurance cards and an ID will need to be present at the time of your appointment. You are responsible for any insurance co-payments, co-insurance, deductibles or non-covered services.Co-payments- All co-payments are due at time of service. This charge is the responsibility of the patient along with coinsurance/deductible balances.Billing Questions – If you have questions about a bill for a date of service after 11/1/19 and would like to speak to a representative, please contact Avadyne at 877-444-6382.Bad Debt Collections – If you have questions about your statement, please call the number on your statement.Refunds – If you have a question about a refund, contact Anderson Healthcare’s Patient Financial Services at 618-391-6956.Forms- There is a $25.00 fee associated with form completion. Insurance companies do not reimburse for form completion and the fee cannot be billed to the patient. All form fees will be collected when forms are picked up. All form fees are due prior to faxing or mailing the completed form. Forms are completed within 7 days.ANDERSON MEDICAL GROUPNORAH BAKER, MD AND GARY STEINMANN, PA-C10 PROFESSIONAL PARK DR., MARYVILLE, IL 62062618-288-7244Acknowledgment of Office Policies for Norah Baker, MD and Gary Steinmann, PA-CPatient Name _________________________________________ DOB ________________________ (PLEASE PRINT)I have read and understand the office policies for Norah Baker, MD and Gary Steinmann, PA-C. I have been provided a copy of the policies to keep for future reference. Patient or Legal Guardian Signature Date Signed ................
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