CASH/SELF PAY PATIENTS
Please see below for our new self-pay pricing (effective Jan 1, 2024):
- New Patient General Visit - $150
- New Chief Complaint Visit (established patients) - $135
Hospital Follow Up - $150
- Follow Up Visits (for a condition previously addressed) - $100
- Well Woman Visit (includes all routine lab work for this type of visit) - $350
- Physical Visit (includes all routine lab work for this type of visit) - $300 ; $330 (for men over 50)
- Insurance Opt Out (if you choose to pay cash vs use your insurance ? Medicaid/Medicare ineligible) - $135
All prices above are subject to change if there is additional testing or lab work to be done.
INSURANCE PATIENTS
Copays are due at the time of service! You are financially responsible for any balance due including paying at least $135 at the time of service if you have a deductible that has not been met. This form authorizes Horizon Medical Associates or your insurance company to release any information required to process your claims.
By signing, you agree that any debit or credit card used for payment will be securely saved in Horizon Medical Associates' database to be used for any outstanding balances and/or future balances, from deductibles, coinsurances, copays or any other uncovered service.
ALL PATIENTS
Form Fees: If you have paperwork that needs to be filled out for any reason there is an admin fee based on the complexity of the form. These fees are due before form completion - please allow 5 business days for the physician to complete your form.
By signing below, I have read and agree to the above terms and understand that if I cannot pay for my visit today, I will be referred immediately to the urgent care/ emergency room because of my situation. If I decide not to go to the urgent care/ emergency room, I will NOT hold Horizon Medical Associates liable for any adverse outcome that may be attributed to my decision.
(serves as signature)
