Patient Financial Rights and Responsibilities

All co-payments and past-due balances are due at the time of check-in unless previous arrangements have been made. We accept cash, personal checks, and credit cards. For plans that carry a co-insurance or deductible, every effort will be made at checkout to accurately estimate your financial responsibility for the day’s charges. Unprocessed charges will be included on your next statement. Any overpayment will be refunded once all insurance claims have been processed by your health plan and any outstanding patient balance has been satisfied.

We require all insurance information, including primary and secondary insurance, be presented with  each visit so we may properly bill for services rendered. This includes virtual visits. Failure to provide  complete insurance information at the time of check-in may result in the patient/guarantor being held  responsible for the entire bill. We collect known amounts due at the time of service and file a claim to  the insurance company, however, it is the insurance company that makes the final determination of  eligibility, benefits, and financial obligation. If there is a discrepancy with insurance information  provided to us, the patient will be considered self-pay until the correct information is provided. It is  your responsibility to understand the scope and specifics of your benefit plan to include co-insurance  and deductible application. 

If we are not contracted with your insurance plan, we will provide you with an itemized statement to  submit to your plan for reimbursement. We ask that you pay all charges for the services provided at the  time of service, less a discount. If all charges are not available at the time of check-out, a statement will  be mailed, reflecting the remaining balance due. The balance is due upon receipt. 

In the event you wish to receive a service not included in your current benefit plan, you will be asked to  sign an acceptance of financial obligation and full payment will be expected prior to the service being  rendered. 

For services billed to your insurance and determined to not be covered by your current benefit plan at  the time of claim processing, payment is expected upon receipt of your first statement. 

In both situations, a discount may be applied to the total billed amount.

Self-pay patients are patients without insurance coverage or without a current insurance card on file  with us. Self-pay patients will be required to pay $50 at the time of check-in towards the day’s charges.  We ask that you agree to pay the remaining balance for the services provided at the time of service, less  a discount. If all charges are not available at the time of check-out a statement will be mailed, reflecting  the remaining balance due. Payment arrangements are available if needed, but a minimal monthly payment is required to resolve the balance in a reasonable amount of time. Please ask to speak with a  Customer Service Representative to discuss a mutually agreeable payment plan at (910) 395-4188 or toll  free at (800) 763-3303.

It is your right, under the HITECH Act, to request your visit not be filed with your insurance company.  Per the HITECH requirements, payment in full will be required at the time of check out along with a  written request to withhold the insurance claim. A written request and payment in full will be required  for each date of service. 

Payment in full is expected on receipt of your statement. If the balance cannot be paid in full, a  reasonable payment plan can be established. Timely payments are expected. The statement will reflect  the amount you owe, if any, after your insurance has processed your claim. If full payment or a  reasonable payment plan cannot be established within 120 days from the first statement date, the  account will be sent to a collection agency. Repeated failure to pay a balance due may result in  dismissal from the practice. 

If there is a question about the charges on your bill or you do not agree with a decision regarding the  charges on your bill, please contact the Customer Service Department prior to 120 days. 

This financial policy helps your Medical Care Team provide quality care to all of Wilmington Health’s  patients. If you have any questions or need clarification of any of the above, please contact our  Customer Service Department at (910) 395-4188 or toll free at (800) 763-3303.

In-person payments can be made via cash, check, or credit card at any of our locations. Over-the-phone  payments can be made via check or credit card by calling (910) 395-4188 or (800) 763-3303. Online  payments can be made via echeck or credit card by visiting our website or logging into your patient  portal. 

Information available at the time a procedure or test is ordered will be used to provide an estimation of  your portion of the cost. Full payment of the estimated cost is expected prior to the service being  performed. If full payment cannot be made, services can be scheduled for a more convenient time. For  non-elective services, a payment plan can be established with a credit card on file. 

Financial assistance is available for those patients, with or without insurance, who meet the Federal  Poverty Guidelines-based qualifications. Approved assistance will be applied to a single episode of care.  Please speak to a Customer Service Representative to request a Financial Assistance Application.

If you need to cancel an appointment, we ask for at least a 24-hour notice. This allows us to offer the  appointment to another patient. If you miss your appointments without canceling ahead of time, you  may be required to pay a $50 pre-payment to schedule future appointments. Continued missed  appointments may result in being dismissed from the practice.  

1. First no show: Patient receives a letter. 

2. Second no show: Along with another letter, patient is notified that they will not be rescheduled  anywhere in the clinic unless they first make a pre-payment of $50. This money will be applied to their  financial responsibility to the practice. 

3. Third no show: Letter will go out informing the patient that they have been dismissed from the clinic. 

The charge for a returned check is $25 payable by cash or money order. This will be applied to your  account in addition to the insufficient funds amount. You may be placed on a cash-only basis following  any returned check.  

A nominal fee, as recommended by North Carolina State Statute, may be charged for copies of  medical records. Please complete the Authorization to Release Medical Records Form available on our  website and follow the instructions on the form for submission.  

The parent(s) or legal guardian(s) authorizing medical treatment is responsible for payment. 

It is your responsibility to provide updated demographics, including insurance information, as soon as  possible. This includes your mailing address, email, and phone number(s). Updates can be provided  in person, over the phone, or via patient portal billing message.