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We are committed in caring for you.

Our goal is to keep your insurance and other financial arrangements as simple as possible. In order to accomplish this effectively, we ask that you adhere to the following guidelines: 

  1. I am ultimately responsible for payment of charges for services I receive in your office. Any check payment dishonored by my bank will result in a $30.00 returned check charge added to my account. 

  2. It is my responsibility to provide the office with my current address, telephone number and insurance information.

  3. It is my responsibility to contact my insurance carrier to confirm that the providers participate with my plan. If I see a provider that is not currently on my plan, I will be responsible for payment in full.

  4. It is my responsibility to confirm with my insurance carrier that services provided through your office, including telemedicine, are covered by my plan. If services are not covered, I will be responsible for payment in full.

  5. If I do not provide correct insurance information (primary insurance), I will be responsible for payment in full. 

  6. If my insurance plan requires a referral, it is my responsibility to obtain this prior to being seen by the doctor. (If the office is required to obtain the referral for you, please notify our office at least 72 hours prior so that we have ample time to acquire this information from your insurance company.) 

  7. Co-payment, co-insurance and / or deductible not satisfied, is due at the time of service or at the time of scheduling my telemedicine appointment. 

  8. If I am a self-pay patient, I will be responsible for payment in full and am responsible for asking about your self-pay rates prior to my appointment. 

  9. Laboratory services is provided by a contracted outside reference lab. I will be responsible for lab charges not covered by my medical insurance. I will contact the number on these invoices for any questions. I accept responsibility for valid lab charges not covered by my medical insurance plan. RHM will not be able to provide lab benefits or estimate of the cost of lab services. This must be obtained from the lab and/or my insurance carrier. 

  10. If my account is referred to an outside collection agency this will result in termination of medical care and will be subject to a collection fee of up to 25%. This will be added to the total balance due at the time the account is turned over to a collection agency. 

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