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Dr. Mucci's New Patient Forms ..... (lower case user name & password required) Costs to the Patient Due to the variable nature of insurance reimbursement and authorization, patients are responsible for contacting their insurance carrier for coverage. Call us or fax (714-516-9502) with your insurance information and we will assist you with evaluating the extent of your insurance coverage. Deposits, Co pays Co Insurance and Deductibles are due at the time of service. If you have any questions regarding the necessary forms or payment policy, please feel free to contact our office at 714-516-9501 or email gmucci@neuropsychologyservices.com
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Deposit Required Due to the high frequency of insurance payment denials for "services not covered", after the initial diagnostic appointment (90801) and review of coverage, we may require a $250.00 deposit for "non covered services". 48 hour notice is required for cancellation. The deposit will be used to fulfill any co-pays, coinsurances or deductibles and non-covered services. Upon completion and payment for services, any remaining deposit balance will be refunded promptly. As a patient convenience, we accept credit cards, personal checks and cash for deposits and services.
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Testing Services with Written Report Full payment for services, including report production, must be received before a written report is provided. Hearings or Testimony Participation A full retainer must be received prior to the scheduling of any hearings or procedures requiring attendance and/or testimony, including preparation time and records review. Insurance Payments For out of network insurance carriers, we allow 60 days from date of submission for insurance carriers to properly pay charges. If after 60 days, the insurance carrier has not made the appropriate payments, the charges will be billed to the patient directly as per our financial responsibility agreement. |
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