Patient Responsibility:

Patient and/or guarantor are responsible for charges incurred.  It is a courtesy for Salem Surgical to file a patient’s insurance. However the patient is responsible for his/her copay and/or percentage which the insurance company is not liable for on the day of visit.  In the event the insurance company has not paid within 60 days, the patient is responsible for the balance due.  It is also the responsibility of the patient to give us accurate, up-to-date insurance information.  If the patient fails to give us accurate information, and later updates insurance information after the timely filing period, the patient will be responsible for the balance we are unable to collect from the insurance.  Returned checks will be charged a $25 fee.

Referral Policy:

Some insurance companies require a referral from the primary care physician, which is processed through the insurance company.

It is the patient’s responsibility to obtain referrals from his/her primary care physician when required. If the referral is not obtained before the visit, the patient is liable for payment in full on the date of service.  We also may reschedule the appointment until the referral is received. If we are unable to obtain payment within a reasonable amount of time from the patient and/or guarantor we will place your account with a collection attorney which will leave you liable for additional expenses incurred, if applicable.

Collections Policy: 

If Salem Surgical is unable to obtain payment within a reasonable amount of time from the patient and/or guarantor, we will place your account with a collection attorney which will leave you liable for additional expenses incurred, if applicable. 

Discount Policy:

Salem Surgical will give self-pay patients a discount for services.  Patients will also be eligible for discounts on an individual basis in the following circumstances:  payment in full a time of service, prompt payment discount, and need basis.  Self-pay patients will be expected to make a deposit of $125.00 at each visit.  They will then be billed the balance.  Discounts will not be given where the total amount collected is less than what Salem Surgical charges Medicare.  Need Based/Charity Care cases will be based upon financial income versus monthly living expenses.  Our Practice Manager will determine Charity Care cases.