Patient Financial Policy

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 information, etc).

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 Claims
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.

Participating Insurances

Blue Shield Federal Plans
BCBSRI Blue Chip

Commonwealth Care Alliance
First Health
Harvard Pilgrim Healthcare
Neighborhood Health of RI
Railroad Medicare
RI Medicaid
Tufts Health Plans
United HealthCare
US Family Health



Participating Insurances

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 necessary if not obtained.

Self-pay Accounts
Self-pay accounts are patients without insurance coverage, patients covered by insurance plans in which our practice does not participate, or patients without an insurance card on file with us.  Liability and workers’ comp cases will also be considered self-pay accounts.  We do not accept attorney letters or contingency payments.  It is always the patients’ 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 pay $95 at the initial appointment (walk-in and RCC) and will be asked to make payment arrangements for the balance.  Imaging patients must pay $200 at the appointment and will be asked to make payment arrangements for the balance.  Payment arrangements are available if needed.  Please ask to speak with a collection 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 stress.

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.

Workers' Compensation
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. We DO NOT participate with Department of Labor US (Workers' Compensation). 


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.


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.

Returned Checks
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 us.