Office & Financial Policy
Canceled Appointments: We request a 24-hour notice if you are unable to keep a scheduled appointment. Please call our office so that we can reschedule your appointment. Carolina Orthopaedic & Sports Medicine Center reserves the right to charge a no-show fee. Excessive no-shows will result in possible termination from the practice.
No Insurance: We require patients without insurance to provide a deposit of $200 at the time of service and the remaining balance is due at check-out. If you are unable to pay your balance in full, you will need to make prior arrangements with a financial counselor.
Liability Injury: Carolina Orthopaedic & Sports Medicine Center does not provide deferred billing for liability cases. Payment for these services is required at the time of service.
Insurance: Please bring your insurance card with you at the time of your appointment. Insurance plans with which we contract require that all co-pays be paid prior to any services being rendered. The co-pay requirement cannot be waived by our practice as it is a requirement placed on you by your insurance carrier. If you do not have your co-pay at the time of your visit, your appointment may be rescheduled.
You are responsible for any co-insurance, deductibles, or non-covered services as required by your insurance. You will receive a statement from our office indicating what your insurance has paid. Any remaining balance is due upon receipt of that statement.
Workers’ Compensation: Workplace injury care requires authorization from your employer’s workers’ compensation carrier before we can file any of your medical claims. Failure to properly report this injury to your employer may result in your claims being denied. Denied claims will be your responsibility.
High Deductible Health Plans: High Deductible Health Plans (HDHP) are consumer-driven health plans that have a minimum deductible and out of pocket limit that is set each year and adjusted for inflation, if necessary. If you have a HDHP, Carolina Orthopaedic & Sports Medicine Center requires a deposit fee to hold your surgical appointment. The deposit will be applied to the patient balance that is not paid by your health insurance plan (such as deductibles, co-insurances, co-pays, and/or non-covered services).
Referrals: Many insurance plans with which we participate require a referral from your primary care physician before receiving services. Please bring the referral with you to your appointment. Any services provided without a referral or proper authorization will be your responsibility.
UCR (Usual and Customary Rate): We are committed to providing the best possible care for our patients and we charge what is usual and customary for our area. If we do not have a contract with your insurance company, you are responsible for payment in full regardless of any insurance company’s arbitrary determination of UCR rates.
Delinquent Accounts: Delinquent accounts may be assigned to a collection agency. All collection costs will be added to your outstanding balance. Failure to pay a delinquent account will result in refusal to schedule appointments for you and/or possible termination from the practice.
Returned Checks: A $25 charge will be added to your account for any checks returned or ACH withdrawals rejected by your bank for any reason. This is in addition to any fees that your financial institution may charge you.
Disability or Insurance Forms: There will be a charge of $15 for the completion of medical forms. Payment is due at the time that you pick up the forms. Please allow 7 – 10 days for the completion of these forms. If you would like the forms mailed to you or your insurance company, payment will be due prior to mailing.
Medical Records: We will provide you a copy of your medical records upon request. A signed letter of release will be required at the time of pick-up. Please allow 7-10 days for us to copy your records. If you wish for your records to be mailed, there may be an associated fee to cover the mailing costs. You may be charged for additional copies of your medical records. Rates charged are within North Carolina state statutes.
X-Rays: We will provide a copy of your X-rays upon request. A signed letter of release will be required at the time of pick-up. Please allow 48 hours from the time of your request. There is a $5 charge per CD containing your X-rays and payment will be due at the time of pick-up.
Fracture Care: Fracture Care is billed-out as a “packaged” service which includes the following:
- The first cast or splint application
- 90 days of postoperative follow-up care from the date of the fracture
Services that are billed separately include:
- All casting supplies
- Replacement cast applications
- Evaluations for any additional problems or injuries
- Treatment of complications.
Your insurance carrier requires that we report our services using the coding system known as the Current Procedural Terminology (CPT). The codes for fracture care can be found in the "surgery" section of the CPT book. This is not to imply that you will have or had surgery or that you will be or were taken to the operating room. This is how the CPT book was set up by the American Medical Association (AMA) for user-friendly purposes by both the insurance companies and physicians. Please note, your insurance company may cover these services for fracture care differently than office visits. Therefore, your services may be paid as a surgical procedure, with deductible and co-insurance guidelines applied.
If you have any questions or concerns regarding our Financial Policy, please contact our billing department at 704-865-0077.