The Chicago Pain Clinics do everything possible to minimize the cost of medical care. You
can help a great deal by eliminating the need for us to bill you. The following is summary of
our payment policy.
All payment is expected at the time of service.
Payment is required at the time services are rendered unless other arrangements have been
made in advance. This includes applicable co-insurance and co-payments for participating
insurance companies. The Doctors Pain Clinic accepts cash, personal checks. There is a 30 $
service charge for returned checks.
Patients with an outstanding balance of 60 days overdue must make arrangements for
payment prior to scheduling appointments. We realize that people have financial difficulty.
Please communicate with our billing and collection staff so that they may assist to create a
We bill participating insurance companies as a courtesy to you. You are expected to pay
your deductibles and co-payments at the time of service. If we have not received payment
from your insurance company, you will be expected to pay the balance in full. You are
responsible for all charges.
Over payments will be refunded upon written request to the responsible party within 30
days of our office confirmation.
Missed Appointments /Untimely Cancellations
Missed appointments represent a cost to us, to you and to other patients who could have
been seen in the time set aside for you. If you are unable to keep your appointment, please
give 24-hours notice to avoid charge. We reserve the right to charge for missed or untimely
canceled appointments. Excessive abuse of scheduled appointments may result in discharge
from the practice.
CHICAGO PAIN CLINICS L.L.C
|FAX # 800-525-1686