Terms & Policies
Thank you for choosing the WISH clinic as your healthcare provider. The physicians and staff are committed to delivering service, compassion and quality to you. Understanding our Billing Policy is an important part of our professional relationship. Below is an explanation of our Payment and Cancellation / No-Show policies. Please make yourself aware of both of these policies as you will sign-off on them prior to your visit.
WISH, a division of Urology Associates, P.C., currently participates in over 2,000 insurance plans. To ensure our institute is In-Network with your policy please contact your insurance carrier. Your insurance co-payment* is due at the time of your visit. If you are unable to pay your co-payment at the time of your visit we will reschedule your appointment. If we determine you have a deductible* or co-insurance* amount due you will be asked to pay this amount at the time of your visit.
If your insurance carrier requires you to obtain a referral from your primary care physician in order for you to see a specialist it is your responsibility to bring the referral with you to your visit. If you do not have a referral we will reschedule your appointment until you can obtain one. Our office will assist you in obtaining pre-certification from your insurance plan if required. If your insurance company is out of network with our practice you will be responsible for payment in full at the time of your visit.
You will be responsible for 100% of your total out-of-pocket* responsibility amount prior to your procedure.
For self-pay patients a $150.00 co-payment is due at check-in. A credit card on file is required for the remaining balance which is expected to be paid in full at the check-out desk at the end of your visit.
We do our best to estimate your financial responsibility prior to any service provided, but please understand this is only an estimate.
- Co-Payment (Copay) - Fixed amount you pay at each visit for services provided such as an office visit. (You pay your copay at the time of service, even if you have met your deductible, until you meet your Out-Of-Pocket maximum).
- Deductible - The yearly amount you must pay before your insurance carrier begins to pay.
- Co-Insurance - The percentage you pay for care even after your deductible is paid in full.
- Out-Of-Pocket - Costs you have to pay yourself.
- Out-Of-Pocket Maximum - The most money you will pay in one year for all covered services. This usually includes all out-of-pocket costs: co-payments, deductibles, and co-insurance.
CANCELLATION | no show | Reschedule POLICY:
In order to provide the best care and service to our patients we ask that you notify us 24 hours in advance to cancel and/or reschedule your office appointment. If you do not cancel, or fail to show up for the appointment, there will be a $50.00 fee charged to your account. Failure to reschedule less than 24 business hours prior prior to your scheduled appointment time will result in a $50.00 cancellation fee.
In addition, cancellation of a scheduled procedure requires 72 hours' notice. Any procedure cancellation not made 72 hours in advance will be subject to a fee of $150.00. Failure to reschedule less than 72 business hours prior to your scheduled procedure time will results in a $150.00 cancellation fee. A reschedule fee of $75.00 will be charged each time a procedure or surgery appointment is rescheduled.
*The cancellation, no show and reschedule fees will not be billed to your insurance.
At WISH we request all new patients bring the completed application that was mailed to you. This application provides detailed information for our physicians to better understand your reason for visiting. In addition to the completed application please provide the following:
- Current list of ALL medications
- Clinical notes from referring physician or primary care physician
- Photo identification
- Current insurance card
patient rightS and responsibilities:
Information Disclosure - Patients have the right to receive accurate, easily understood information about their health plans, our professionals and facilities.
Choice of Providers - Patients have the right to a choice of health care providers, sufficient to ensure access to appropriate high quality health care.
Participation in Treatment Decisions - Patients have the right and responsibility to fully participate in all decisions related to their health care. Patients who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators.
Respect and Non-Discrimination - Patients have the right to considerate, respectful care from all members of this health care institute. Patients must not be discriminated against in the delivery of health care services. An environment of mutual respect is essential to maintain a quality health care system. Patients must not be discriminated against in the delivery of health care services consistent with the benefits covered in their policy or as required by law.
Confidentiality of Health Information - Please review our HIPAA policy here.
Complaints and Appeals - All patients have the right to a fair and efficient process for resolving differences with their health plans, health care providers, and the institutions that serve them.
Patient Responsibilities - Greater individual involvement by patients in their care increases the likelihood of achieving the best outcomes and helps support a quality improvement, cost conscious environment. Among other acts, patients should:
- Take responsibility for maximizing healthy habits
- Become involved in specific health care decisions, working collaboratively with providers
- Disclose relevant information, wants and needs
- Use the health plan's complaint and appeal process to address concerns
- Recognize the limits of medical science, and the fallibility and competing responsibilities of providers
- Understand health insurance plan coverage, options, and requirements
- Meet financial obligations
- Report wrong-doing and fraud