Mona Venzon Rice, MD – Financial Policy

Fee Schedule for Visits

Description

Fee

New Patient Evaluation (60-75 minutes)

$300

Follow-up Appointment (30 minutes)

$140

Payment and Insurance Information

Credit Card on File

A valid credit card is required to schedule appointments. This card will be used to charge for no-show, missed appointment or late cancellation fees when appropriate. You will be notified at the time of remittance of these charges. Credit card information is stored in a Payment Card Industry Data Security Standard (PCI DSS) – compliant database.

Payment and Insurance Information

Dr. Rice is currently not participating with any government (e.g. Medicaid) or private health insurance. You are responsible for the full cost of services. Payment is due in full at the time of the appointment. Dr. Rice will not file any claims to insurance for you.  The following forms of payment are accepted: cash, checks, VISA, Mastercard, Discover & American Express.  Checks should be written out to: “Mona Venzon Rice, M.D., P.C.”  There is a returned check fee of $35.00.

Unpaid Balances

If unable to collect on a balance owed, legal means may be used to secure payment, which may include hiring a collection agency. Unless the balance is paid, Dr. Rice may be unable to continue treatment.

Fee Schedule for Missed Appointments

Description

Fee

Missed Appointment / No Show / Late Cancellation– New Patient Evaluation

$150

Missed Appointment / No Show / Late Cancellation– Follow-up

$75