Financial Policy of Mountain Peaks Urology:

  1. Payment is due the same day services are rendered.  For your convenience we accept cash, personal checks, money orders, Visa and Mastercard. Returned checks may be subject to a non-sufficient funds fee of $25.
  2. Please make sure you give us a copy of all insurances, and know which is primary and which is secondary.  If you’ve purchased a Medicare Advantage plan also known as a buyout plan (these include: United Healthcare/Secure Horizons, Humana, or Aetna), it’s your responsibility to notify us. If you do not give us a correct and active insurance card within the time period allowed to bill your insurance, all relevant charges may become your responsiblity for payment.
  3. You are responsible for notifying our office of any requirements of your insurance company for the preauthorization prior to any procedure or visit, whether done in the office or in the hospital. You are also responsible to verify that a preauthorization has been completed prior to any procedure. If a referral/authorization is not obtained and if necessary, you will be responsible for the charges. 
  4. You may be asked to pay your coinsurance, deductible, and/or co-pay (if any are applicable) on the day that services are provided such as office visit, treatment, procedure, or surgery. I understand that I am responsible for any amount not covered by insurance and any collection costs should this account be assigned for collections.
  5. We will consider a payment plan for some accounts, but this needs to be set up and approved prior to your scheduled visit or procedure.
  6. We may apply a monthly finance charge on all account balances over 30 days. The annual percentage rate is 8%. In addition, all accounts turned over to a collection agency will be assessed a penalty charge equal to 35% of the total balance of the account. Patients may be responsible for any attorney fees incurred from the collection process.
  7. Appointments cancelled or rescheduled without at least 24 hours notice, may be charged a $25 cancellation fee. This will be billed directly to the patient, not the insurance, in accordance with insurance guidelines. There is a $125 fee for missing a scheduled CMG appointment without 48 hours notice. Patients who repeatedly miss appointments may be required to provide a refundable deposit for the appointment (forfeited if the appointment is missed).