Since its inception on January 1, 2004 the physicians and staff of Lawrence Family Medicine & Obstetrics have attempted to provide you the highest quality obstetrical and family medical care, as well as timely access to care. We recognize that most of our patients take their financial responsibilities very seriously and pay their bills in a timely manner. Unfortunately, that description does not apply to everyone and our policies must be consistent. We find it necessary to adopt the following financial policies.  

Presentation of health insurance card:   It is necessary for us to verify your demographic and insurance information at each visit. It is essential that we have your accurate and current insurance card at each visit.  If you forget your insurance card it may be necessary to reschedule your appointment.  

Payment at the time of service:   We are a medical office and do not have the resources to be a credit agency. We require payment at the time services are rendered.  If you are uninsured and unable to pay at the time service, please contact the business office to discuss payment options.  

We will file all health insurance claims, all co-pays are due at the time of service. Failure to pay your co-pay may require rescheduling your appointment.  

Billing cycle:   You will receive a statement after your insurance company has paid your claim. This balance is due upon receipt. Failure to pay your balance may result in your account being turned to collections and your dismissal from our office.          

Collection charges:   Should your account be turned to collections a collection fee plus interest may be added to your balance.     

No Show Policy:   If you fail to come to your scheduled appointment or arrive later than 10 minutes from the scheduled appointment time, there will be a $25.00 charge applied to your account. You may be asked to reschedule your appointment, if 10 minutes or more late.   

Charity Policy:   We recognize that some individuals may have the need to receive medical care that is beyond their financial means to pay. LFM&O supports and participates in Health Care Access, a community funded clinic. HCA provides medical care for those persons with no health insurance and who do not qualify for government funded insurance programs. If you anticipate financial difficulty in paying for medical services please ask for a referral to HCA.    

We appreciate your review of these policies. Please let us know if you have questions or concerns.

I have read the Lawrence Family Medicine & Obstetrics Financial Policy. I have been given a copy of the policy and agree that our financial relationship shall be governed by its contents.

Please download the PDF of this document to be signed by the patient or guardian

Revised on 7/8/2014