Payments of all copays, deductibles, and/or coinsurance are due at the time of service. As a service to you, our office will bill your insurance company. Being a participating provider with most insurance companies, the insurance companies require that we collect these fees, as they are terms of your health care contract. Additionally, patients are ultimately responsible for all balances.

For your convenience, we accept credit cards including Visa, MasterCard, American Express, and Debit Cards.

Due to the constant changes in health insurance it is your responsibility to know your health coverage. If you should have any questions regarding if a certain procedure is covered, it is to your advantage to call your insurance company and find out exactly what your contract covers. Their customer service representatives will be happy to assist you.

You will be charged a $25 fee in the event that you don’t cancel your appointment within 24 hours or you don’t show for your scheduled appointment.

If you wish to release your records to another physician or someone else, you must sign a release with that office. They will notify us and we will process the request. Most requests are handled in seven to ten days.

The doctor will be delighted to fill out any medical form for patients. However, ample time must be given. It will take approximately one to two business days for the forms to be completed. There may be a charge of up to $20.00 per form.

For a list of all our forms: Click Here

Michigan Premier Internists’ mission is to provide you with the highest quality medical care possible. With this in mind we are constantly trying to control our costs while conforming to the standard fee schedules approved by most major insurance companies.

Our receptionist will attempt to verify your insurance coverage prior to your visit and determine if the services that are likely to be performed are a covered benefit.

1. Your medical insurance card and personal identification must be presented to the receptionist at each visit.
2. Any outstanding balances should be paid before your office visit or procedure, unless prior payment arrangements have been made.
3. Your insurance is a contract between you and the insurance company. While we accept the reimbursement rates of many insurance companies, we are not a party to your contract and do not determine which is medically necessary services they cover and which they do not.
4. Our relationship and treatment responsibility is with/to you, We will attempt to notify you whenever we know a test or service is not covered. There will, however, be times when we cannot determine this. Whether covered or not, you are ultimately responsible for payment of the services received.
5. We require payment in full on the date of service for co-pay and offices charges defined under your policy as your responsibility.
6. A $5 administrative fee for delayed payment will be added to your balance if you choose not to pay at the time of services are rendered or after one statement sent to your home, unless prior payment arrangements have been made. This $5 fee is not billable to your insurance company, it is your responsibility. To avoid this fee, you must pay at the time of service or after you receive your first statement.
7. We expect you to call us if you are not able to make it your appointment. For your convenience, we may make an attempt to remind you of your appointment. Your appointment is a reservation of the office’s, staff’s and doctor’s time and resources. A charge of $25 for office visits will be made for appointments that are not cancelled 24 hours in advance…

We realize that on occasion, temporary financial problems may affect timely payment of your account. If such problems arise, we encourage you to contact us promptly for assistance.

I have read and understand the terms listed above.

OUR POLICY
Your trust is very important to us and our Practice is strongly committed to protecting your privacy. We have created the following Privacy Statement to give you an overview of the type of information we collect, how the information is used and how the information is safeguarded.

CHANGES TO OUR POLICY
Our Practice may make changes to the Privacy Statement at any time. If we do so, we will post those changes on our Website so you are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. Please review our Privacy Statement periodically to see recent changes.

ADDRESSING PRIVACY CONCERNS
If you have any questions about this Privacy Statement please contact us:

Michigan Premier Internists
Farmbrook Medical Building #2
29877 Telegraph Rd. Ste. 401
Southfield, MI 48034

248-354-0730
248-354-1652 (fax)

WHAT INFORMATION IS COLLECTED
This Privacy Statement applies only to information collected through our Website. Our Practice collects information about you through the information you provide to us. On some areas of our Website, we may collect certain information that you provide in order to register or to make online appointments with us or to use our Services. Such information may include:

• Contact information, such as name, mailing address, e-mail address and phone number
• Shipping or transaction information, such as billing address and credit card information, if you choose to purchase goods from our Practice
• Information provided in connection with online registration for seminars or other events offered through our Website
• Demographic information, such as zip code, age and gender
• Patient contact information such as name, mailing address, phone number, e-mail address and medical and insurance information (e.g. health background and health status)
• Information you enter in forms and optional surveys
• Information provided in e-mail requests and communications

WHAT INFORMATION IS SHARED WITH THIRD PARTIES?
Our Practice may disclose information you provide to us to independent contractors, service providers and consultants who assist us in providing healthcare services to you via our Website. Such service providers may include, without limitation, credit card processing and shipping companies. However, we will only share such personally identifiable information, as we deem necessary for them to carry out their obligations to our Practice.

We may also share aggregated demographic information with independent contractors, service providers, consultants, and other partners. This is not linked to any personal information that can identify any individual person. Our Practice may also disclose personal information it has collected if necessary to fulfill our service obligations or if we are required to do so by law, or if in our good faith judgment, such action is reasonably necessary to comply with legal process.

LINKING
Our Website may offer links to other Websites. Please be aware that we are not responsible for the privacy Practices of such linked Websites, including Websites of our partners. We encourage our users to be aware when they leave our Website to read the privacy statements of each and every Website that collects personally identifiable information. This privacy statement applies solely to information collected by our Website.

DISCLAIMER
Unfortunately, no data protection method or combination of methods can be guaranteed 100 percent secure. We strive to protect your personal information as described throughout this policy, but we cannot ensure or warrant our ability to do so. As a result, you use our content, products, and services at your own risk. We will not be liable for disclosures of your personal information due to errors in transmission or unauthorized acts of third parties.