Policies and Forms

Thank you for choosing Advanced Regional Center For Ankle & Foot Care to serve your health care needs. Your clear understanding of our financial policy is important to our professional relationship. Our staff will be pleased to discuss our professional fees with you at any time and are always willing to answer any questions you may have.

For your convenience we accept cash, checks, Discover, MasterCard or Visa.

Insurances

If you have insurance, we will do all we can to help you receive maximum benefits.

Insurance is a contract between you and your insurance company. We are not a party to this contract. Your claims will be handled according to the terms of our agreement with the insurance company, if one exists. We are a participating provider with Aetna, Keystone and Select Blue Shield (HMO and PPO), Blue Cross/Blue Shield, Blair Mill, Health America (HMO and PPO), UMWA, Medicare, and numerous individual companies.

We do participate in the Medicaid Assistance Program, Access, Gateway, and Three Rivers. However you must have an updated card before service will be given. NOTE: co-payments on the Access Card are due at the time of service, and Access members under 18 years of age require a referral from your Primary Care Physician (PCP). Also, Gateway and Three Rivers require referrals from your PCP that MUST be with the patient or received by our office prior to seeing the doctor for service.

We will file all insurance claims. However, if you require a referral this is solely your responsibility. If you do not receive a referral from your PCP, you may be responsible for all charges incurred at your visit. We will not become involved in disputes between you and your insurance company regarding deductibles, co-payments and covered and non-covered charges other than to supply factual information as necessary. You are responsible for the timely payment of your account. Medicare patients are responsible for their $100 yearly deductible and 20% not covered by Medicare if they do not have a supplemental insurance.

We will submit all surgeries, x-rays, injections, etc. to your insurance company. However, you are responsible for office calls at the time of service unless it is a covered service under your insurance plan.

We do use other facilities such as hospitals, laboratories, etc. for blood work and cultures. We will use the facilities that your HMO or PPO requires.

We know at times patients do not have insurance. If this is the case, you will be responsible for payment at the time services are rendered. If emergency treatment is needed, a payment plan will be set up to assist you. It will be your responsibility to meet the terms of the agreement.

If you have any questions regarding our policy please ask our staff for clarification.

Forms

Click here to download ALL paperwork

--- download separate paperwork below ---

Click here for Financial Policy Form

Click here for Confidential Data Sheet Medical History Page 1

Click here for Confidential Data Sheet Medical History Page 2

Click here for Privacy Policy