INDIANAPOLIS
8240 Naab Road
Suite 100
Indianapolis, IN 46260
P: 317-338-7450

FISHERS
13914 Southeastern Pkwy
Suite 202
Fishers, IN 46037
P: 317-415-9330


Financial Policy and Patient Liability

The financial policy of the Naab Road Surgical Group, P.C. is that payment is expected at time of service.

Should you have insurance, please remember that it is a contract between you and the carrier and we are not a part of that contract. Insurance is a means of payment and not a transfer of personal responsibility. We cannot render services on the assumption that our charges will be paid by an insurance company. All services are charged directly to the patient, and he or she remains personally responsible for payment. As a courtesy, however, we will prepare and submit any necessary claim forms, reports and itemizations to assist in making collections from insurance companies and will credit any such collections to the patientís account.

In order to better serve you, we have contracts with a number of insurance companies and health plans to provide services at specific reimbursement rates. We also accept Medicare assignment. However, these plans include co-pays, annual deductibles, and reimbursement at less that 100% of the approved bill leaving you with some personal financial responsibility. Most of the plans include provisions to pay for the services within a specific number of days after the claim has been filed. Our experience has been that a number of insurance companies and health plans have not met their contractual agreements to pay Naab Road Surgical Group, P.C. within the specified time frame. If your insurance company or health plan does not pay for services we have provided within our contractually agreed upon terms, we will look to you for payment.

Besides payment through an insurance carrier or health plan, we accept payment by cash, check and credit card. It is the policy of this practice to send only 2 patient balance statements. After that, your balance due may be forwarded to a collection agency for further follow-up. Should a situation arise where a payment plan is the best means to satisfy a debt, we can make those arrangements. If you disagree with your carrierís settlement of your claim, you will need to pay the balance due and appeal directly to your carrier. Should we reach the point where we must seek the assistance of a collection agency or attorney to satisfy your debt, you will be responsible for any attorney fees, court costs and prejudgment interest at the statutory rate.

Some of you will require preparation of disability/FMLA documents in order for you to receive pay during any absence from work. We provide this service but charge $35.00 for each form. It is in your best interest to bring disability documents with you at the time of your initial visit.

With the understanding of the financial policy stated in this document, I now make the following release of information and insurance authorizations.

I authorize release of information on my care to my insurance companies. I understand I am responsible for my bill. I understand that if I expect any portion of my bill to be reimbursed or paid by insurance or prepaid health plan, it is my responsibility to ensure that my physician has met my carrierís requirements. I authorize payment directly to my physician on all insurance submissions. I authorize my physician to act as my agent to help me obtain payment from my insurance companies. I authorize my insurance companies to give my physician or my physicianís assigns any information they require to fulfill this function.


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