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Financial Policy at Express Family Clinic


Nowadays, most of our medical bills involve health insurance, which can be very complicated. We realize this, and our goal is to make things as simple as possible for you. We also ask for your assistance to simplify our processes. Here are our policies:


Please bring your insurance card to the office for every visit.


Always be sure to tell us right away when you get new insurance coverage. You must bring you insurance card on your first visit, as well as at any time your insurance coverage changes. It is your responsibility to determine that we are contracted providers before being seen. We are not responsible for changes in your insurance.


Please update your address, telephone, and employer information with us.


Please call our business office if your information changes before your next visit.


In-Network Insurance coverage


Many insurance providers offer a wide variety of plans or sub-products. It is your responsibility to determine that we are contracted providers with your exact insurance plan before being seen. While we are contracted with most major insurance providers, we may be out-of-network with some of its sub-products.


We are not responsible for laboratory billing.


Laboratory billing is separate to the physician bill you receive. We are not responsible for any laboratory billing issues that arise after the service provided. We can suggest labs as part of your annual checkup or medical conditions, but we do not provide any guarantee for its insurance coverage.


Health Savings Account / High Deductible Insurance Plan


We hold the right to collect an upfront amount before the service is provided. We will bill the insurance after the service is given; and the remaining amount, after the insurance adjustment, shall be the patient’s responsibility.


We do not bill third-party insurance.


If you have been injured in an auto accident, you must tell the front office staff when you check in. You will be responsible for the payment in full at the time of service.


When your insurance delays payment.


If your insurance carrier does not make payment within 90 days, the balance will be due in full from you. If there is a problem or dispute over payment with the insurance carrier, this is a matter for you to pursue with them. If any payment is subsequently made by your insurance carrier in excess of the balance we estimated, we will promptly refund the credit amount to you.


When your insurance denies a claim.


If your insurance denies a claim, you will be billed for all services not covered in accordance with our insurance contracts. This may include, but are not limited to, denials due to eligibility, out-of-network services, not covered services, and maximum benefits have been reached.


Missed appointments and cancellation.


We want to be available to meet your health needs. If you must cancel or reschedule your appointment, please call us 24 hours in advance. There will be a missed appointment fee of $25 if we receive less than 24 hours advanced notice or if you fail to show up for your appointment.


Medical Records


There will be a charge for copying materials from your chart when done other than at the time of a visit including the transfer of records to another facility.


Payment is due at the time of service.


If you cannot pay our co payment at the time of the visit, we will add a billing fee on top of the co payment. We will not bill secondary insurance plans for copays. A copay may be due regardless of whether you see a physician for an office visit; that is, if you have a nurse visit for an injection, there will be copay assessed by your insurance company for that visit. If you have a deductible that must be met each year before the insurance starts to cover the visits, please know what that deductible is, and pay for visit at the time of service. If we do not have confirmation that you are covered by an insurance plan, you will be expected to pay the charges in full at the time of the visit. When we receive an insurance payment, we will promptly refund you payment.


If you have no insurance, or if we are not able to verify your insurance eligibility, we ask that you pay for the visit at the time of service.


There may be times when you are between jobs or otherwise without health insurance coverage. There may also be times when your new insurance coverage has not yet registered with your insurance plan or the IPA. In these instances, we ask that you pay for the visit at the time of service. We will bill your new insurance. If they cover the claim, we will gladly refund you.


Payment options


For your convenience, we accept most major credit cards including Visa, MasterCard, Discover, American Express.  We do not accept checks. If these options do not work for you, we can make arrangements to set up a payment plan. If you need this extra consideration, we ask that you set this up in advance with our office.


Medical Forms


There will be a charge for filling out forms when it is not done at the time of an appointment, including school forms, child care forms, and immunization cards. There is $5 per page charge for forms completed as part of an office visit.



Collection Agency Reporting Policy


You must notify us of any errors or objections to billing statements within (30) days or they will be deemed accurate, and the fees and expenses shall be deemed reasonable and necessary for the services incurred. If any balance on your account is over 60 days past due, your account will be in default and may be referred to a collection agency.


Non-Payment on Account - Should collection proceedings or other legal action become necessary to collect an overdue or delinquent account, you understand we have the right to disclose to an outside collection agency or attorney all relevant personal and account information necessary to collect payment for services rendered. You are responsible for all costs of collections including, but not limited to: (1) late fees and charges due as a result of such delinquency; (2) all court costs and fees; (3) any collection fee to be charged under a separate agreement with a third-party collection agency, and to be added to the outstanding balance due and owing at the time of the referral to the third-party collection agency.



I have read and understand the above information. I also understand that no guarantees have been made to me about my insurance coverage; and I do not hold Express Family Clinic, or any of its physicians or staff responsible for my insurance coverage, pre-authorization or other insurance decisions.


Express Family Clinic
940 Ridgeview Drive, Suite 150
Allen, TX 75013
Phone: 972-672-4121
Fax: (972) 905-4690

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