We know that your time is valuable. To expedite your appointment check-in, completing the following forms ahead of time will speed up the process. Please complete, print, and sign the required documents. Bring these with you to your first appointment so we can serve you better.
Aetna US Healthcare
Blue Cross/Blue Shield
Health Net Federal Services
Integrated Health Plan, Inc
Labor And Industry (L&I)
Lifewise Health Plan Of Washington
Molina Health Care
PacifiCare Plan/Secure Horizons (Meridian)
Premera Blue Cross & Microsoft Division
Payment Due At Time Of Service
Return Check Fees
Past Due Accounts
Thank you for choosing Northwest Foot and Ankle Center, PS 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 Supervisor Matt Roth at (425) 900-2626
PUNCTUALITY IS APPRECIATED BY OUR OFFICE. IF YOU ARE MORE THEN FIFTEEN MINUTES LATE TO YOUR APPOINTMENT THEN IT MAY BE NECESSARY TO RESCHEDULE TO ANOTHER DAY.
PRESCRIPTIONS WILL NOT BE REFILLED AFTER 4:00PM OR ON WEEKENDS, EXCEPT FOR EMERGENCY CASES. FOR MEDICATION REFILLS, PLEASE CALL YOUR PHARMACY 48 HOURS IN ADVANCE TO HAVE THE REFILL REQUEST FAXED TO OUR OFFICE FOR APPROVAL. IF YOUR MEDICATION IS IN THE NARCOTIC FAMILY, IT WILL REQUIRE A PHYSICAL PRESCRIPTION AND MUST BE REQUESTED 48 HOURS IN ADVANCE.
5 BUSINESS DAYS NOTICE IS 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.
Patients with Insurance: We will file your insurance claim for you. However, in order to work with your insurance company, we must have complete and current information as well as a copy of your insurance card and your signature on file.
Denied Claim:You will be responsible for any charges that are denied by your insurance company which result from your failure to provide our office with complete and current information in a timely manner. It is your responsibility to inform us of any changes in insurance benefits.
Referrals: If your insurance requires that you obtain a referral from your Primary Care Physician; it is your responsibility to ensure that our office receives the referral prior to your visit. If a referral is not in place, you will be responsible to pay in full at the time of service. Although we do our best to check for you, it is ultimately the responsibility of the patient.
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. If payment is not received from these third parties within 90 days, we have the right to bill you directly.
Self-pay patients: Payment in full is due at the time of service.
Durable Medical Equipment: Our office will assist in determining coverage for Durable Medical Equipment (braces, splints, boots, walkers, and/or orthotics as needed. This means any and all procedures, treatments and care will be billed to you and your insurance. This does not guarantee payment by your insurance company. Any item not covered by insurance is deemed “patient responsibility.”
Insurance benefits: It is your responsibility to know your insurance benefits. Please contact your insurance company with any questions that you may have regarding coverage of podiatric services.
Copayments, Co-Insurances and Deductibles: All patient balances are due at the time of service. Patients with private insurance plans (non-Medicare/Medicaid) that include deductibles will need to pay at the time of service. If copays are required by your plan, payment at time of service will also be due. Northwest Foot and Ankle Center, PS reserves the right to refuse treatment if required payments are not made at the time of service. For your convenience, all major credit cards are accepted.
Non-Covered Charges: Please understand there may be some charges for our services which your insurance company considers non-covered and may be excluded from your policy. Accordingly, you will be responsible for these charges.
Returned checks: Any returned check is subject up to a $45.00 bank fee.
Past due accounts: We will send a statement to the mailing address you provide notifying you of any outstanding balances. If you do not respond to the first statement within 30 days of receipt and additional statements are mailed, a $10 re-billing fee will be added each month. If you are not able to pay your balance in full, you must contact our billing office to discuss a possible payment plan. If you then fail to make payments, your account may be referred to a professional collection agency and/or attorney and will be subject to a 35% fee.