There are a number of separate charges associated with your procedure. You MAY receive charges from several companies.
Full payment is due within 60 days from your date of service. Please contact your insurance company directly if you experience any delays. YOU are responsible for guaranteeing payment on your account and being aware of your individual policy restrictions and benefits.
Your insurance company, including Worker's Compensation, auto (no fault) and personal injury, is legally responsible to you. Our relationship is with you, our patient, not your insurance company. Consequently, all charges incurred are your responsibility. The obligation to assure payment in a timely manner lies with you regardless of what your insurance company chooses to do. You should normally receive a response from your insurance company within 30 days of your date of service. If you experience a delay, it is expected that you contact your insurance company to check the status of your claim and to expedite payment. Please call our Business Office at 817-423-2888 if you encounter a problem with your insurance company and need our assistance.
The Southwest Fort Worth Endoscopy Center’s policy is to turn over to a collection agency all accounts which are delinquent. You will be responsible for any collection fees that are incurred.
We utilize Transworld Systems as our collection agency.
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THE SOUTHWEST FORT WORTH ENDOSCOPY CENTER WILL BILL AS FOLLOWS:
MEDICARE We accept assignment of benefits.
PRIVATE INSURANCE Your copay amount is due on or before your date of service. We will submit your bill directly to your private insurance company. A bill will be sent to your secondary insurance upon receipt of payment or denial from your primary insurance. If you have no secondary insurance, a bill will be sent to you for any balance after receipt of payment or denial from your insurance company. We must make a copy of each insurance card at the time of registration.
SELF PAY You will be contacted prior to your surgery with an estimated cost for your procedure A down payment equal to 1/3 of the total estimated amount due is expected. You will be asked to complete a financial agreement. The remaining balance will be due within 60 days from your date of service.
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6317 Harris Parkway
Fort Worth, TX 76132