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Credit Card on File Notice

We have implemented a policy requiring a credit card to be held on file. As you may be aware, the current healthcare market has resulted in insurance policies increasingly transferring costs to you, the insured. Some insurance plans require deductibles and copayments in amounts not known to you or us at the time of your visit.

Similar to hotels and car rental agencies, you are asked for a credit card number at the time you check in and the information will be held securely until your insurances have paid their portion and notified us of the amount of your share, you will receive a statement.  You may have more than one card on file as well.

Each account will be reviewed prior to a charge being made.  Any adjustments will be applied before a charge is made.  In the event you have overpaid, we will have a card on file to refund your overpayment immediately!

At the time a bill is generated, you will be contacted to advise you of the amount to be charged before the charge is processed.  We will contact you through the patient portal messaging (where your bill is presented), by email, and/or by phone.  This in no way will compromise your ability to dispute a charge or question your insurance company’s determination of payment.

Other charges that may be incurred are and charged to your credit card on file:

  • No Show $40.00 (appointment was not canceled at least 1 business day before the appointment).  We call, email, and send reminders through the patient portal the day before your appointment, we expect you to contact us if you are not going to keep your appointment in a timely fashion so that we can provide the time to another patient.

  • Bills due that exceed 30 days will be charged 1.5% for each unpaid billing cycle.  With credit card on file, this won’t be necessary!

  • Forms requiring a physician’s evaluation and review are generally not paid for by insurance companies, (even when it is their own form!).  It is important to note that when the physician signs a health related form, he or she is certifying the facts of your health to the best of his or her knowledge.  These become legal documents and part of the chart, thus we take them very seriously.  The charge for forms completion is $40.00.

  • Multi-page forms regarding a physical and evaluation are $80.00.  Further, these must be done at the time of an appointment.

  • Claims Denied Due to Inactive Insurance, Terminated Insurance, Expenses Incurred Prior to Effective Date, Other Insurance Company is Primary


The presentation of invalid insurance information is a form of insurance fraud. Ultimately, you are responsible for all charges.   We will contact you to find out if there is another insurance on file, an error was made at the insurance company, etc.


If there is any question that your insurance may not be active it is best to schedule an appointment after you have determined the status of your insurance.

  • You have elected to take COBRA after leaving an employer – your employer will terminate the policy and upon receipt of your payment will “reactivate” the policy as a COBRA member.  There may be a 45 day window for you to select COBRA, pay your employer, and the insurance company to reactive you.  You must verify that the insurance is active before scheduling an appointment.

  • You were just hired, but don’t have your insurance card yet – schedule your appointment after you have received your insurance card.

  • There are two policies (such as with spouses or two jobs providing health insurance benefits) – you need to know which one is primary and which one is secondary so that claims can be properly submitted the first time.  If you are unsure as to which policy is primary (and it is not necessarily the one with the best benefits!), call your insurance companies to verify before coming to your appointment.


If you have any questions about this payment method, do not hesitate to ask.

Sincerely yours,

Joel C. Ang, MD, FAAFP

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