Billing and Insurance Policy Pg 2.

4) Interest (or a flat re-bill charge of $5) will be added to unpaid patient portions after 30 days for cash-pay or 30 days after insurance has paid.

5) Missed appointments:
? These will be charged at the rate of your co-pay to a maximum of $20 for cash-pay or private insurance patients. Medi-Cal/Central Coast Alliance patients will have missed appointments reported to CCAH per our contract.

6) Forms:
? Our office will be glad to complete other forms for you. Depending on the situation (such as complexity and urgency), we may charge you an additional fee for filling out forms not directly related to insurance filing. This charge is payable when the form is brought in. They cannot be done the day the form is brought in, so please be sure to see that we have the form as soon as possible.
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