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Dear Patient:

Welcome to Go Orthopedics. Our goal is to provide the highest level of orthopedic care for your problems. We will make every effort to meet your needs. Please recognize that Dr. Goradia treats problems related to the upper and lower limbs. He is not a spine specialist but will see sports injuries of the spine and occasionally other spine problems. If needed, he will recommend that you follow-up with a spine specialist.

The policies listed below are meant to help familiarize you with our practice. Please do not hesitate to ask questions if any of these are unclear. You may also want to visit our web site for additional information about the practice, Dr. Goradia’s qualifications & experience or for educational materials.

1. Co-Payments:

All co-payments ARE EXPECTED WHEN SERVICES PRIOR TO BEING SEEN. Many insurances have separate co-payments or deductibles for x-rays, injections and casts. These will also need to be paid at time of service. We accept Visa, Mastercard, Cash and Checks. Please understand that our contract with your insurance requires us to collect co-payments at time of service. We cannot bill you later for these payments.

2. Patients without Insurance:

If you do not have a valid proof of insurance or if you have a deductible you are required to pay a deposit at time of check in. The deposit will be $90.00 if you bring your own x-rays to your appointment and $175.00 deposit if we perform x-rays in the office. Keep in mind that these payments are only a deposit; your total bill will be determined by the type of treatment you receive. The remaining balance will be billed to you. Also, recognize that the doctor may need to obtain additional x-rays in the office or schedule other tests to assist in making the diagnosis.

3. Returned Checks:

There is a $20.00 returned check fee. If you have two returned checks, we will only accept cash or credit card payments during future visits.

4. Form Processing Fee:

There is 10.00 fee for the office to complete each form such as FMLA, disability, etc. Forms are processed by our office within five (5) business days of receiving them. You must fill out a medical release in order for us to release any medical information. We will call and let you know when your forms are ready for you to pick up or if you prefer, we can fax or mail them for you.

5. Requests for Copies of Medical Records:

IAW VA State Law 8.01-413: There will be a $10 search and handling fee for retrieving, reviewing, preparing, copying and mailing copies of medical records. In addition to the $10 handling fee, copies will be billed at $0.50 per page up to 50 pages and $0.25 per page for every page thereafter. All Postage and shipping costs will also be charged for mailing copies. Charges will be due before receipt of all copies picked up in person, or due in advance for all copies to be mailed out.

6. Brace Policy:

Braces provided by Go Orthopedics are billed through OrthoRx. They will bill your insurance company. The balance will be billed to you. You may be responsible for the entire amount, a deductible or co-payment.

7. MRI, CT Scans, other test(s), and surgeries:

If the physician orders a test and/or surgery for you, Go Orthopedics will call your insurance company and obtain pre-authorization if it is required. It is your responsibility to call your insurance company to determine how much of the cost the insurance will cover, and how much you are responsible to pay. Most plans require patients to pay co-payments, deductibles or a percentage of the total bill.

8. Billing office:

Our billing is completed by Medical Reimbursements Associates (MRA). If you have any questions about your bill, please call Lisa at 804-378-4936. If she cannot answer your questions, please call us.

9. Referrals:

If referrals are required by YOUR insurance company it is your responsibility to obtain them from your primary care physician. If you do not have the referral at time of appointment, you may sign a waiver stating that you will obtain the referral later and send it to us. If you fail to do so you will be responsible for full payment of all services at time of appointment.

From time to time these policies may be modified as needed; additional policies may also be added to this list. Please feel free to let us know if you have any questions and welcome to the practice.

Sincerely,

The Staff of Go Orthopedics