Thank you for choosing Medical Associates of
RI, Inc. (MARI) as your health care provider. We are committed to
building a successful physician-patient relationship with you and your
family. Your clear understanding of our Patient Financial Policy is
important to our professional relationship. Please understand that
payment for services is a part of that relationship. Please ask if you
have any questions about our fees, our policies, or your
responsibilities. It is your responsibility to notify our office of
any patient information changes (i.e. address, name, insurance
The patient is expected to present an insurance card at each visit. All
co-payments and past due balances are due at time of check-in unless
previous arrangements have been made with a billing coordinator. We
accept cash, check or credit cards. Absolutely no post-dated checks
will be accepted.
Insurance is a contract between you and your insurance company. In most
cases, we are NOT a party of this contract. We will bill your primary
insurance company as a courtesy to you. In order to properly bill your
insurance company we require that you disclose all insurance information
including primary and secondary insurance, as well as, any change of
insurance information. Failure to provide complete insurance
information may result in patient responsibility for the entire bill.
Although we may estimate what your insurance company may pay, it is the
insurance company that makes the final determination of your eligibility
and benefits. If your insurance company is not contracted with us, you
agree to pay any portion of the charges not covered by insurance,
including but not limited to those charges above the usual and customary
allowance. If we are out of network for your insurance company and
your insurance pays you directly, you are responsible for payment and
agree to forward the payment to us immediately.
Shield Federal Plans
Shield of RI & PPO Plans
MA (RI PCP only)
Medicare of RI
of Rhode Island
Value Mgm't (HCVM)
Coast to Coast
Health of RI
Horizons UHC AARP
If your insurance plan is one with which we are not a participating provider, you will be responsible for payment in full. However, as a courtesy, we will file your initial insurance claim and if not paid within 30 days you will be responsible.
Referrals and Preauthorizations
Certain health insurances (HMO,POS, etc.) require that you obtain a referral or prior authorization from you Primary Care Provider (PCP) before visiting a specialist. If your insurance company requires a referral and/or
preauthorization, you are responsible for obtaining it. Failure to
obtain the referral and/or preauthorization may result in a lower or no
payment from the insurance company, and the balance will be your
responsibility. Alternative payment arrangements or rescheduling of your appointment may be necessry if not obtained.
Self-pay accounts are patients without insurance coverage,
patients covered by insurance plans in which the office does not
participate, or patients without an insurance card on file with us.
Liability cases will also be considered self-pay accounts. We do not
accept attorney letters or contingency payments. It is always the
patient’s responsibility to know if our office is participating with
their plan. If there is a discrepancy with our information, the patient
will be considered self-pay unless otherwise proven. Self-pay patients
will be required to bring $100 at the initial appointment if not being
seen for fracture and will be asked to make payment arrangements for the
balance. Imaging patients must present $200 at the initial appointment
and will be asked to make payment arrangements for the balance.
Extended payment arrangements are available if needed. Please ask to
speak with a billing coordinator to discuss a mutually agreeable payment
plan. It is never our intention to cause hardship to our patients, only
to provide them with the best care possible and the least amount of
Motor Vehicle Accident (MVA) and Third Party Billing
We do not do any third party billing. Our relationship is with you and not with the third party liability insurance (auto, homeowner, etc.) It is your responsibility to seek reimbursement from them. However, at your request, we will submit a claim to your primary health insurance carrier. You may receive an accident questionnaire from them to be completed by you. If the questionnaire is not returned to your medical insurance company and/or we receive a denial on your claim, you will be responsible for payment in full.
It is the patient's responsibility to provide our office staff with employer authorization/contact information regarding a workers' compensation claim. If the claim is denied by the workers' compensation insurance carrier, it then becomes the patient's responsibility. At your request, we will submit the claim to your primary medical insurance carrier with a copy of the workers' compensation insurance denial. If your primary medical insurance carrier's claim is denied, you will be responsible for payment in full.
CANCELLATION OF APPOINTMENTS
If it is necessary to cancel a scheduled appointment, we require at least 24 hours advance notice.
Late Cancellations: A late cancellation is considered when a patient fails to cancel their scheduled appointment with a 24 hour advance notice.
No-shows: a no-show is when a patient misses an appointment with no notice or shows up too late to the appointment to be seen.
A $50.00 fee will be billed to your account for late cancellations and for no-shows.
Repeatedly missing visits jeopardizes your care. For this reason after an ESTABLISHED patient has two (2) late cancellations and/or no-shows or a NEW PATIENT has one (1) cancellation or no-show, they will be discharged from the practice.
COMPLETION OF FORMS POLICY
In order for us to better serve you, we request that you are aware of the following:
Your insurance company will not be billed as insurance companies do not reimburse for the time and judgment that are required to complete these forms.
Please allow 7 business days for completion of forms.
Payment is required prior to completion of all form(s)
The fee for completion of forms varies from $20 to $40 depending on time and complexity.
The charge for a returned check is $35 payable by cash or
money order. This will be applied to your account in addition to the
insufficient funds amount. You may be placed on a cash only basis
following any returned check.
Medical Record Copies
Patients requesting copies of medical records will be charged:
$10 – under 20 pages
$15 – 21 to 49 pages
$20 – over 50 pages
Attorneys and Insurance companies will be charged a $15 fee, plus postage, plus:
$.25 per page – under 100 pages
$.10 per page – over 100 pages
$15 for an itemized bill
A special handling fee of $10 will be charged if records must be delivered within 48 hours of the request.
The parent(s) or guardian(s) is responsible for full payment
and will receive the billing statements. A signed release to treat may
be required for unaccompanied minors.
Outstanding Balance Policy
It is our office policy that all past due accounts be sent
two statements. If payment is not made on the account, a single phone
call will be made to try to make payment arrangements. If no resolution
can be made, the account will be sent to the collection agency, or
attorney, and possible discharge from the practice.
In the event an account is turned over for collections, the
person financially responsible for the account will be responsible for
all collections costs including attorney fees and court costs.
Regardless of any personal arrangements that a patient might
have outside of our office, if you are over 18 years of age and
receiving treatment, you are ultimately responsible for payment of the
service. Our office will not bill any other personal party.
This financial policy helps the office provide quality
care to our valued patients. If you have any questions or need
clarification of any of the above policies, please feel free to contact
MEDICAL ASSOCIATES OF RI, INC. RESERVES THE RIGHT TO CHANGE AND/OR MODIFY THE INFORMATION ON THIS SITE AT ANY TIME.