All new patients must complete the Patient Registration Form prior to seeing a physician and must present their insurance card at each appointment for verification of eligibility.

Payment in full is due at the time of service.  Parents or legal guardians signing the Patient Registration Form are responsible for payment of treatment rendered to minors.

We accept cash, checks, and Visa/Mastercard as payment for services rendered.

Tri-City Family Medicine participates in most major insurance plans.  Please check with our office to determine if we participate in your plan.

As a participating provider with your insurance plan, you are responsible for your copay at the time of service.  We must report failure to pay your copay to your insurance carrier.

Please be aware that some services may be “non-covered” per your insurance benefit plan.  For these services, you will be expected to pay at the time of service.  Examples of a non-covered service may be an office visit, injections, or a splint.

As a convenience to our patients, we submit claims to your health insurance carrier for you. This includes both primary and secondary carriers and requires you to provide us with your complete plan information, which usually can be found on your insurance card.  This card must be presented at each appointment.

Claims not paid in 45 days by the insurance carrier become your responsibility.  Patient statements are mailed monthly and “patient due” balances shown on your monthly statement are due upon receipt.

Insurance is a contract between you and your insurance company.  In the event we do not participate in your insurance plan, you are responsible for payment in full at the time of service (please refer page entitled “Referrals / Managed Care” for more details on “Insurance”).

The physicians of Tri-City Family Medicine are participating providers with Medicare.  Individuals covered by Medicare will be responsible for any “non-covered” services at the time of service delivery.

Please check with our office to determine if we are taking new Medicaid patients.  Individuals covered by Ohio Medicaid must present their current card at the time of service for verification of eligibility.

Effective January 1, 2001, Tri-City Family Medicine no longer accepts Bureau of Workers’ Compensation cases.  If you sustain an injury while “on the job”, you will need to check with the Benefits Administrator at your place of employment for your employer’s contracted BWC provider.

Please notify us of any changes in your health insurance coverage, employer, home address or phone number.

There will be a $35 charge to your account for any check presented for payment which is returned by the bank for any reason.

A $20 charge to your account will be made if it becomes necessary to turn your account over to a collection agency for non-payment for services provided.

Thank you for understanding our financial policies.  Any questions about our policies, your statement or account may be directed to the Patient Accounting Office at (440) 366-6575 or the Ohio toll-free number at (800) 589-2359.