Office Financial Policy+
All appointments require 24-hour notice of cancellation or you will be charged a $40 fee, which must be paid before future appointments are made. All charges for services rendered are due at the time of service, including copays, coinsurance, and deductibles. As a courtesy we will file your insurance claim; if Dr. Lewis is not contracted with your insurer, you will be given the information needed to file the claim yourself. Routine foot care (e.g. trimming nails, calluses, corns) may not be covered by your insurance.
Patient Financial Policy (Detailed)+
Your insurance policy is a contract between you and your insurance company. If your insurance does not pay within the legally specified period, you are responsible for payment. We accept cash, debit/credit cards, checks, and money orders. There is a $25 fee for returned checks, and additional forms (FMLA, disability paperwork, etc.) carry a $25–$50 fee depending on length. Past-due accounts may be subject to collections, including attorney and court fees.
Notice of Privacy Practices (HIPAA)+
I understand that under HIPAA I have certain rights to privacy regarding my protected health information, and that this information may be used to conduct, plan and direct my treatment, obtain payment from third-party payers, and conduct normal healthcare operations. I acknowledge that I may request a current copy of the Notice of Privacy Practices at any time.
Release of Medical Information+
I authorize Weatherford Podiatry Clinics, P.A. to release medical information as necessary to process my insurance claims and coordinate my care.
By submitting, I attest that the information provided is accurate to the best of my knowledge and I understand that providing incorrect information could be dangerous to my health.