Policies & Billing

Thank you for choosing Atrium OB/GYN, Inc. as your provider.  We are committed to providing you with quality and affordable health care.  Our practice financial policy is as follows: 

 1. Insurance.  We participate in most managed care plans.  If you are insured by a plan that we do not participate with, payment in full is required at each visit.  If you are unable to provide Atrium OB/GYN with an up-to-date insurance card, payment in full for each visit will be required until we can verify your coverage.  Contact your managed care plan directly for any questions regarding your coverage.  By signing this form you authorize Atrium OB/GYN, Inc. to release the necessary information in order to complete and process your insurance claims.

 2. Claims Submission. The billing department will submit a claim to your managed care plan if you provide a current insurance card at each visit.  Please note that the insurance coverage is between you and your insurance carrier; we will file the claim for you, but the balance is your responsibility if your plan does not pay after 30 days.  We do not offer third party billing; the patient or the patient’s responsible party is responsible for handling all third party billing.

 3. Non-covered Services.   I understand that some and perhaps all of the services I receive may not be covered by my insurance company or not considered reasonable or necessary by Medicare or other insurers.  I agree to pay for any services which have been determined by my insurance plan to be “non-covered”.  Payment in full is generally due at each visit or immediately after you receive your first Atrium OB/GYN, Inc. statement. 

 4. Copays and Deductibles.  You are required to pay for your visit at the time of service if you have not yet met your annual deductible.  We will provide you with a receipt.  Copays are always due at the time of service.  This arrangement is part of your contract with your insurance company.  The exception would be if your plan does not require a copay for the visit.

 5. Updates.  Our staff will ask you to verify billing information at each visit.  Current information is essential in order for us to contact you regarding your treatment and for obtaining timely payment from your insurance company.          

 6. Knowing Your Plan.  Patients should know the requirements of their individual current plans.  Your plan may change annually and you should always know what your plan intends to pay for services and your financial responsibility.  The billing department at Atrium OB/GYN, Inc. does pre-certify your OB care and surgeries as a courtesy. 

 7. Laboratory Services.  We will submit your specimens to Quest Diagnostic or Aultman Lab depending on your plan.

 8. Missed Appointments.  We charge $25.00 for missed appointments, as that appointment time could have been given to another patient that needed to be seen.  This is not billable to your insurance.

 9. Forms of Payment.  We accept Cash, Check, Money Order, Debit Cards, Visa, Mastercard, Discover and Care Credit.

 10. Non-sufficient Funds Checks.  You will be charged a $30.00 processing fee for NSF checks presented to the practice. 

 11. Additional Information.  We do charge for copying medical records, form completion, and after hours prescription refills.

 If you have any billing questions, please contact our billing department at 330-492-2083.  For a PDF version of this form click here.

 Revised 12/15/2009

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Atrium OBGYN, Inc.
4151 Holiday St. NW
Canton, OH 44718
Ph: 330.492.8001

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