Thank you for choosing Streamline Orthotics and Prosthetics. We are committed to providing you with the best available care. In order to make sure that all your needs are met, our billing department is available to discuss any questions you may have regarding your co-insurance and this policy with you.

We ask that all responsible parties please read and sign that you have read and received a copy of our financial policy prior to seeing your clinician.

Payments for all coinsurance, deductibles or any out-of-pocket expense for custom items will be due before the device is ordered or fabricated. In order to serve you better, we accept cash, check, Visa, MasterCard, Discover, Amex, and Care Credit.

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PLEASE READ THE FOLLOWING CAREFULLY

1. Unpaid balances from prior services are due before you receive new services.

2. Returned checks and unpaid balances may be subject to collection placement and collection fees.

3. If your prescribed device is not covered by insurance or if you do not have insurance, full payment will be required before your item will be ordered or fabricated.

4. We will contact your insurance provider to verify benefits and provide you with a quote for services. You will be asked to approve the expense before we order or fabricate your item.

5. All services are the responsibility of the patient/guardian. Benefits quoted by your insurance company are not a guarantee of payment. The information we provide to you about your benefits is from your insurance company. Nothing is guaranteed by your insurer until the claim is adjudicated.

6. Please note, we cannot bill your insurance company until the device has been delivered to you. Keep in mind if you are changing insurance plans, or your plan’s anniversary date is coming due, your quote may change.

7. Custom prescribed items are the responsibility of the patient/guardian. Once the fabrication process has begun the item is the responsibility of the patient/guardian. If you fail to pick up the custom device that was prescribed for you by your physician, you and your insurance company will still be billed.

8. The above does not apply to Workers’ Compensation. However, be advised that as a compensation patient you may be held responsible for changes in the event your claim is controverted.

9. It is the patient/guardian’s responsibility to be sure all information for primary and secondary insurance is up to date and correct and communicated to our billing department.

We understand that financial problems may affect timely payment, we encourage you to communicate any problems to our billing department so that we may assist you in keeping your account in good standing. Please contact our billing department with any questions at (314) 289-9100 Opt. 3.