Financial Policy

Thank you for choosing Dr. DeVito as your health care provider. We are committed to the successful treatment of your condition. Please understand that payment of your bill is considered part of your treatment. Should you have any questions regarding any aspect of your financial status with our office, please feel free to contact our billing department at 630-924-0156.

Your clear understanding of our Financial Policy is important to our professional relationship.

  • We are happy to bill your insurance directly; however, we must have a copy of the insurance card
  •  If you do not have your insurance card with you, full payment is due at the time of service. We accept Cash, Check, Visa/MasterCard, and Discover.
  • All patients must complete our “Patient Registration Form” and other related forms.
  • Please notify us immediately of any changes in your insurance or coverage.
  • 5-business day’s notice required for copies of medical records or X-Rays and there may be a nominal fee.

Self Pay
We expect payment at the time of service unless prior arrangements have been made.

Medicare
We accept Medicare assignment. As a Medicare patient, you are responsible only for the deductible if you have supplemental insurance. Medicare does not cover a few services and supplies and we will advise you of any non-covered charge prior to the service being provided.

HMO/PPO
ALL CO-PAYMENTS ARE DUE AT THE TIME OF SERVICE. IF YOU DO NOT KNOW YOUR CO-PAY, YOU MAY USE OUR PHONE TO FIND OUT. We are members of most, but not all plans. You are responsible for verifying that we are providers for your plan. If you are an HMO member, you will not be billed as long as we have the necessary referrals. Please note: You must have your referral at the time of the visit or your plan requires that we ask you to reschedule. PPO patients will only be responsible for their deductible, co-payments, and co-insurance, as long as they have verified with their insurance that Dr. Michael A. DeVito is in their plan.

Workers’ Compensation
If you are here because of a work related injury, we will require information regarding both health insurance and your employer’s Workers’ Compensation insurance. Before seeing Dr. DeVito, we will require a letter or statement from the Workers’ Compensation carrier authorizing your treatment. The letter should include the claim number, address, and adjuster’s name and phone number. (Your employer’s human resources office should be able to assist you with obtaining this information.) If payment is not received from these third parties within 90 days, we have the right to bill you directly.

Hospital and Surgery Center Charges
In the event that you undergo surgery in a hospital or ambulatory surgery center, a separate charge will be made by that facility. Dr. DeVito may have a financial interest in a surgery center where you will be having your surgery.

UCR (Usual and Customary Rates)
We are committed to provide the best treatment possible for our patients and we charge what is usual and customary for our area. If we do not have a contract with your insurance company, you are responsible for payment in full regardless of any insurance company’s arbitrary determinations of UCR rates.

Financial Agreement
I understand that I am financially responsible for all charges not covered by insurance and I guarantee the balance to be paid by my credit card, check, or cash. Past due balances may be subject to additional fees.
I understand that if the office agrees to bill insurance as a courtesy, I must submit information as needed to ensure payment for services rendered to me. I understand that I am ultimately responsible for payment for all services. If payment is not received from the insurance carrier or other responsible party in 90 days, I will be billed directly.
 

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Payment Policy

PAYMENT IS DUE AT TIME OF SERVICE

We are committed to providing you with the best possible care.  This information is designed to guide you through the rapidly changing world of healthcare and insurance plans.  Please read carefully and sign the bottom of the page indicating your understanding and acceptance of our policies and procedures.

If you have health insurance, as a courtesy we will submit your claim for you.  We will have you pay for any deductibles and co-pays that apply to your policy at the time of service.

PAYMENT IS DUE AT THE TIME OF SERVICE UNLESS PAYMENT ARRANGEMENTS HAVE BEEN MADE AND APPROVED IN ADVANCE.  We accept Cash, Check, VISA, Mastercard and Discover for your convenience.

YOU MUST REALIZE THAT:

1.) Your insurance is a contract between you, your employer (if applicable) and the insurance company.  We are not included in your contract.

2.) Not all services are covered by all insurance policies.  Some companies select certain services they will not cover. Our Practice has no control over coverage.

3.) The “Usual & Customary Charges” or “Allowed Amount” that may be quoted by your insurance company are charges that have been determined and set by your insurance company.  They do not necessarily reflect our fees.

We must emphasize that as health care providers, our relationship is with you, not your insurance company.  While filing insurance claims for our patients is a courtesy that is extended,  ALL CHARGES ARE YOUR RESPONSIBILITY FROM THE DATE SERVICE IS RENDERED.

We do realize that there are times that a temporary financial problem may affect your payment of your account.  In that case, PLEASE contact our Practice Manager for assistance so we can set up payments for you.
If you have questions, please ask.   We will be glad to help.

REGARDLESS OF ANY INSURANCE COVERAGE THAT I MAY HAVE, I AGREE THAT IT IS MY RESPONSIBILITY TO PAY MY BALANCE AND WILL PAY ANY BALANCE DUE .
 

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