Thank you for choosing Neurology Consultants of Nebraska, P.C. as your health care provider. We are committed to providing the best possible treatment for our patients. This information regarding financial matters will be helpful to you in understanding our billing process.

1. Neurology Consultants of Nebraska, P.C. files insurance claims for patients as a courtesy. Regardless if the patient has an insurance plan, the patient still has full responsibility for payment of the bill. It is also the patient’s responsibility to check to see if the physician he/she is seeing is a participating provider with his/her health plan. 

2. The “patient balance” is due within 28 days of the statement due date, unless you have made other arrangements with the business office. We also will collect all previous outstanding patient balances at the time of your visit. If you have no insurance coverage, payment is due at the time of services. 

3. Co-payments are always due at the time of service. Our contractual agreement with your carrier prevents us from waiving your required co-pay amount. 

4. We accept CASH, CHECK, VISA, MASTERCARD, DISCOVER and AMERICAN EXPRESS. 

5. A $35.00 service charge will be assessed for returned checks. 

6. If you cannot pay in full at time of service, please call the business office at (402) 552-7615 to make other arrangements. Payment plans or other credit services may be utilized. 

7. Payments plans amounts are determined by the amount of the owed balance. When full payment cannot be made, the following guidelines will be followed: 

* Balances up to $300 are to be paid in 3 monthly installments.

* Balances up to $600 are to be paid in 4 monthly installments

* Balances greater than $600 are to be paid in 6 monthly installments. 

8. Call to correct any billing errors promptly. If you ignore our billing statements or telephone calls, we can only assume that you do not intend to pay for the medical services that were provided in good faith and your account will be forwarded to an outside collection agency. 

9. Referrals – some insurance plans require that a referral from the primary care physician be obtained prior to be seen. It is the responsibility of the patient to obtain this referral. If a referral has not been obtained or we are unable to obtain one for you, you will be considered “self pay” and required to pay $285.00 prior to the visit or you may be asked to reschedule your appointment. A follow up visit “self pay” is required to pay $190.00 prior to being seen. 

10. Personal Injury – we will not be a party to any litigation suits filed for personal injuries. We require payment in full and any payment from litigation is to be sought by you for reimbursement. 

11. Work Related Injuries – pre-authorizations for care is the responsibility of the patient. If the prior authorization is not obtained, you are responsible for full payment at the time of service. If your workers compensation carrier has not paid your account within 45 days of the date of service, the owed balanced will become the responsibility of the patient. 

I have read this policy and accept the terms as outlined above: