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Alliance In Health Diabetes Control Center Financial Policies

We would like to thank you for choosing AIHDCC as your medical provider.
We have written this policy to keep you informed of our current financial policies.

No Insurance: Payment will be due at the time of service. If you are unable to pay your balance in full, you will need to make prior arrangements with our Accounts Manager or a Customer Service Representative.

Insurance: Although we are contracted with several insurance companies, it is your responsibility to make sure that our physician is in your plan. It is also your responsibility to know your insurance benefits. As a courtesy to our patients we will file primary insurance forms from our office. We do not file secondary insurance except for Medicare Recipients. In order to do this we will require information from you. We will need all your demographic and insurance information prior to your appointment.

We will also request an update on this information approximately every six months thereafter. We ask that at the time of your appointment you bring your insurance card and a photo ID as well as any other forms that will assist in making sure that your claim is filed correctly. At the time of service you will be responsible for all fees that are not covered by your insurance, including co-pays, co-insurance, deductibles and noncovered services or items received.

The copay cannot be waived by our practice, as it is a requirement placed on you by your insurance carrier. We strive to be as accurate as possible in calculating your responsibility but, with so many variations in policies and fee schedules, we are not always exact. You may receive a statement from our office for any balance due. For your convenience we accept cash, checks, and credit cards (Visa, MasterCard, and Discover). Payments are also accepted by phone.

Auto Accident: If your injury is a result of an auto accident, you are required to pay for services and then collect from the auto carrier. We will not file your insurance but will provide you with a receipt to do so.

Liability Injury: If your injury is a result from another party’s negligence, you are required to pay for services and then collect from the responsible party. We will not file your insurance but will provide you with a receipt to do so.

Worker’s Compensation: If your injury is due to an accident in your workplace, please inform the receptionist immediately. We are not authorized to treat you for this type of claim. You will need to contact your supervisor for instructions on how to file a worker’s compensation claim. We regret any inconvenience this may cause.

Return Checks: Returned checks are handled through TeleCheck at 1-800-366-1054. There will be a charge assessed for any check returned by your bank for any reason.

Disability, Insurance Forms, Attending Physician Statements, FMLA: There will be a charge of $25.00 for the completion of medical forms or you may be required to schedule an appointment. Payment is due at the time that you pick-up these forms. Please allow 7-10 days for the completion of these forms. If you would like the forms mailed to you or the insurance, payment will be due prior to mailing. FMLA forms require that you come in for an Appointment.

Medical Records: We will provide you a copy of your medical records upon request and for a fee. You will need to sign a letter of release prior to having them copied. Please allow up to 30 days for this request to be processed.

X-Rays: We will provide you a copy of your x-rays upon request and for a fee. You will need to sign a letter of release at the time of pick-up. Please allow 48 hours from the time of your request.

Lab Work: A limited number of lab services will be billed by our office. All other services will be billed by the contracted lab. You may receive a bill from DHR Lab, Quest Diagnostics, or LabCorp. Please contact their billing department prior to calling our office. We do not have access to their billing information.

Billing: If you receive a bill from us, it is because we believe the balance is your responsibility. Please contact your insurance company first, if you think there is a problem. If you have any questions about your bill, please call our billing department immediately. If you cannot pay your entire balance, please call to make payment arrangements.

Collections: Accounts that are not paid within 30 days begin our in house collection process. If your balance becomes 65 days old, your doctor will be notified and you may be subject to dismissal from the practice.

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