The Oregon Clinic, West Hills Gastroenterology Colonoscopy Constipation Preparation Instructions (Gatorade/miralax) Page 11
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14Payment Policy
Patient Responsibility
Patients are responsible for all charges resulting from treatment provided by The Oregon Clinic, West Hills
Gastroenterology. Payment is due in full within 30 days of receiving your first statement unless other financial
arrangements have been made with the Business Office.
Co-pays
All co-pays, if required by your plan, are due at the time of service for each visit.
Payment Arrangements
All patients will be required to pay off their balances within 30 days of receiving their first billing unless payment
arrangements have been made with the billing office. Please contact our billing office as soon as possible after
receiving your statement if payment arrangements are needed, (503) 963-2900.
Uninsured Patient Deposits
Patients without insurance will be required to make a deposit at the time of the visit for all appointments, as follows:
New Patient Office Visits- $75
Return Patient Office Visits- $25
Procedures- $250
Referrals & Preauthorizations
The Business Office will attempt to acquire a referral from your primary care doctor if your health plan requires one.
Referrals can be difficult to obtain. Please be aware that if you choose to be seen before you have received a valid
authorization prior to your appointment your insurance may not pay for the visit. If you are having a procedure that
requires prior authorization, the Business Office will obtain this for you. The Business Office cannot guarantee
payment for services or quote benefits from your health plan. Patients are ultimately responsible for knowing their
coverage limitations and benefits.
Insurance Billing
As a courtesy we will bill your primary and secondary insurance for you. However, primary responsibility for the
account is yours. Providing correct insurance billing information is the responsibility of the patient. If your insurance
changes, please present your new card at your visit. All of our providers are participating providers with Medicare. If
you are insured directly through the State of Oregon or are insured through Oregon Health Plan please bring your
current medical card with you to each appointment. If you do not have your insurance card with you at the time of
your visit you will be billed for the services if you have not provided us with valid insurance information.
Cancellation/Rescheduling Fees
If you need to cancel or reschedule your procedure, you must notify us within 3 business days of your procedure time.
You may be charged a $100 cancellation/reschedule fee for insufficient notice for procedures.
If you need to cancel or reschedule your office visit, you must notify us within 1 business day of your office visit time.
You may be charged a $50 cancellation/reschedule fee for insufficient notice for office visits.
No Show Fees
You may be charged $100 for not showing for your scheduled procedure.
You may be charged $50 for not showing for your scheduled office visit.
Interpreter Fees
If we have arranged for an interpreter for your visit or procedure, the interpreter service requires 24 hour notice of
cancellation. If you do not show or late cancel, you may be billed for the interpreter fee in addition to the above.
Collections
We reserve the right to send accounts with balances that have been outstanding over 60 days from the date of
service or the date of payment received from your insurance provider, whichever is more, to a collection agency.
9701 S.W BARNES RD. • SUITE 300 • PORTLAND, OR 97225 • (503) 297-8081 • FAX (503) 292-6601
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