Accepted Insurances
Financial Policy
Summit Walk-In Clinic is recognized for providing complete on-demand healthcare. In order to provide care for you, we need an honest, clear, and direct financial relationship with you. We serve you directly, not your insurance company. As a result, you are ultimately responsible for paying for your care. The following policies explain how Summit Walk-In Clinic bills and collects payment for our services.
Acknowledgment of Financial Responsibility
You acknowledge that you are financially responsible for and agree to pay for all services/products received at Summit Walk-In Clinic. You acknowledge that payment is required at the time of service unless other arrangements, such as the billing of insurance, have been made. Payment for services includes payment of applicable coinsurance, copayments and deductibles for participating insurance companies. Summit Walk In Clinic accepts cash, VISA, MasterCard, Discover Card and American Express. Summit Walk In Clinic does not accept checks in the clinic.
Billing Insurance
As a courtesy to you, Summit Walk In Clinic will bill health insurers with which Summit Walk In Clinic has a contract. However, you understand and agree that you (not the insurance company nor any other entity) are ultimately responsible for all fees for services received at Summit Walk In Clinic. Or, unless otherwise specified by state or federal law or other billing arrangements have been made.
As a benefit to you, if you are using commercial health insurance, Summit Walk In Clinic will run an insurance benefit and eligibility check. This eligibility check will provide you and the clinic with your deductible information (if applicable), co-payment amount (if applicable), and some coverage information. It is your responsibility to understand your benefits and guidelines of your particular plan. We will always bill your insurance first. Many times however, there is a portion of the final bill that is not covered by insurance. Prior to your visit with us, if the amount remaining on your deductible is greater than $100.00, we offer 2 options for financial clarity.
Option 1: Credit Card on File.
During the check-in process, Summit Walk-In Clinic will collect your credit card information in our secure billing system. By keeping your credit card on file with Summit Walk In Clinic, any outstanding charges that have not been paid by your insurance company will be charged to the credit card on file. Your credit card is kept on file until the card expires to ensure that costs associated with any visit are covered. Acknowledging this policy implies consent for us to retain your card information and charge up to, but not more than, $500.00 per transaction for any fees related to your care.
Option 2: $100 Deposit prior to your Office Visit.
During the check-in process, you pay a $100 deposit in additional to any co-payments. After your visit is completed and we have billed your insurance first, any remaining balance that is due will be paid with the $100 that was deposited at check-in. If there is still a balance after the $100 deposit has been applied, Summit Walk-In Clinic will send you a bill. If any money remains from the $100 deposit, Summit Walk-In Clinic will automatically refund it to you.
No Shows and Late Policy for APPOINTMENT MADE VISITS ONLY
You authorize Summit Walk-In Clinic to keep your signature on file and to charge your credit card in the instance of a no-show, no-call or a late arrival of more than 30 minutes (please see our check-in policy for more information). A no-show, no-call charge is up to $100, and a late arrival fee is up to $50. This is a non-refundable Fee.
Assignment of Benefits Statement
If you have health insurance, you authorize your health insurance and health plans to make payments directly to Summit Walk-In Clinic on your behalf. You agree to pay for any charges that are not paid by your insurance.
You understand that if your primary health insurance or health plan does not pay Summit within 60 days of the date of service, Summit Walk-In Clinic may then bill you directly or charge your credit card on file the total amount due.
As a courtesy, Summit Walk-In Clinic will also bill secondary insurance policies. However, if payment is not received from any secondary insurer within 30 days of billing a secondary insurer, Summit Walk-In Clinic may then directly bill you or charge to your credit or debit card on file the total amount billed to the secondary insurer.
You are responsible for knowing your insurance benefits, guidelines, and any services that are covered by your insurance plan. You are responsible for paying Summit Walk-In Clinic for all services and products provided that are not covered by your insurance.
You understand that you are responsible for knowing whether you are eligible to use this insurance at the time of service at Summit Walk-In Clinic. It is your responsibility to provide Summit Walk-In Clinic with valid insurance information at every visit. If your insurance is not in effect at the time of service, Summit Walk In Clinic will charge you the full amount for services received.
Outstanding Balance and Collection Policy
You agree to pay any outstanding balance within 60 days of service.
Charges that are not paid after 90 days of service you will be transferred to a collection agency. If it becomes necessary to involve a collections agency for any amount owed on this or subsequent visits, you agree to pay all legal costs and expenses, including reasonable attorney fees. You hereby authorize Summit Walk-In Clinic to release information necessary to secure payment.
As of 8/24/2016
Acknowledgment of Financial Responsibility
You acknowledge that you are financially responsible for and agree to pay for all services/products received at Summit Walk-In Clinic. You acknowledge that payment is required at the time of service unless other arrangements, such as the billing of insurance, have been made. Payment for services includes payment of applicable coinsurance, copayments and deductibles for participating insurance companies. Summit Walk In Clinic accepts cash, VISA, MasterCard, Discover Card and American Express. Summit Walk In Clinic does not accept checks in the clinic.
Billing Insurance
As a courtesy to you, Summit Walk In Clinic will bill health insurers with which Summit Walk In Clinic has a contract. However, you understand and agree that you (not the insurance company nor any other entity) are ultimately responsible for all fees for services received at Summit Walk In Clinic. Or, unless otherwise specified by state or federal law or other billing arrangements have been made.
As a benefit to you, if you are using commercial health insurance, Summit Walk In Clinic will run an insurance benefit and eligibility check. This eligibility check will provide you and the clinic with your deductible information (if applicable), co-payment amount (if applicable), and some coverage information. It is your responsibility to understand your benefits and guidelines of your particular plan. We will always bill your insurance first. Many times however, there is a portion of the final bill that is not covered by insurance. Prior to your visit with us, if the amount remaining on your deductible is greater than $100.00, we offer 2 options for financial clarity.
Option 1: Credit Card on File.
During the check-in process, Summit Walk-In Clinic will collect your credit card information in our secure billing system. By keeping your credit card on file with Summit Walk In Clinic, any outstanding charges that have not been paid by your insurance company will be charged to the credit card on file. Your credit card is kept on file until the card expires to ensure that costs associated with any visit are covered. Acknowledging this policy implies consent for us to retain your card information and charge up to, but not more than, $500.00 per transaction for any fees related to your care.
Option 2: $100 Deposit prior to your Office Visit.
During the check-in process, you pay a $100 deposit in additional to any co-payments. After your visit is completed and we have billed your insurance first, any remaining balance that is due will be paid with the $100 that was deposited at check-in. If there is still a balance after the $100 deposit has been applied, Summit Walk-In Clinic will send you a bill. If any money remains from the $100 deposit, Summit Walk-In Clinic will automatically refund it to you.
No Shows and Late Policy for APPOINTMENT MADE VISITS ONLY
You authorize Summit Walk-In Clinic to keep your signature on file and to charge your credit card in the instance of a no-show, no-call or a late arrival of more than 30 minutes (please see our check-in policy for more information). A no-show, no-call charge is up to $100, and a late arrival fee is up to $50. This is a non-refundable Fee.
Assignment of Benefits Statement
If you have health insurance, you authorize your health insurance and health plans to make payments directly to Summit Walk-In Clinic on your behalf. You agree to pay for any charges that are not paid by your insurance.
You understand that if your primary health insurance or health plan does not pay Summit within 60 days of the date of service, Summit Walk-In Clinic may then bill you directly or charge your credit card on file the total amount due.
As a courtesy, Summit Walk-In Clinic will also bill secondary insurance policies. However, if payment is not received from any secondary insurer within 30 days of billing a secondary insurer, Summit Walk-In Clinic may then directly bill you or charge to your credit or debit card on file the total amount billed to the secondary insurer.
You are responsible for knowing your insurance benefits, guidelines, and any services that are covered by your insurance plan. You are responsible for paying Summit Walk-In Clinic for all services and products provided that are not covered by your insurance.
You understand that you are responsible for knowing whether you are eligible to use this insurance at the time of service at Summit Walk-In Clinic. It is your responsibility to provide Summit Walk-In Clinic with valid insurance information at every visit. If your insurance is not in effect at the time of service, Summit Walk In Clinic will charge you the full amount for services received.
Outstanding Balance and Collection Policy
You agree to pay any outstanding balance within 60 days of service.
Charges that are not paid after 90 days of service you will be transferred to a collection agency. If it becomes necessary to involve a collections agency for any amount owed on this or subsequent visits, you agree to pay all legal costs and expenses, including reasonable attorney fees. You hereby authorize Summit Walk-In Clinic to release information necessary to secure payment.
As of 8/24/2016
