Billing Info

You must bring your insurance card(s) to every visit and inform us of any changes as they occur.

Moundville Primary Care Associates participates with various insurance companies. We will be happy to assist you, but it is the patient's responsibility to know your insurance benefits, co-pays, deductibles and whether our physician is in network with your insurance policy(ies). Most insurances will not pay for everything. If a service is non-covered, the fees will become the responsibility of the patient or guarantor. All co-pays, deductibles or non-covered charges are due at the time of service regardless of who brings the patient in for his/her visit. We gladly accept Cash, Check, Visa, MasterCard, Discover and American Express as forms of payment. There is a 3.5% processing fee added to all credit transactions.

If you are currently uninsured, Moundville Primary Care Associates requires an initial payment of $100.00, due on the date of service, that will be put towards the charges for your visit. You will be given a Good Faith Estimate for any remaining balance of services rendered.

As a courtesy, we will gladly file your office visit claim to your insurance company. Once your insurance has paid, any patient balances remaining will be billed to the patient or responsible party. If you are unable to make your payment in full, we ask that you contact our billing office to discuss a payment plan. If your balance remains unpaid for 90 days we may, at our discretion, turn your account over to an outside collection agency. You will be responsible for the fees assessed by the collection agency. This outstanding debt may also be listed with local, regional, or national credit-reporting agencies and may have a negative effect on the granting of future credit.

All lab work sent to one of our reference labs for testing, will be billed separately by the reference lab that performs the testing. All DCH labs must go to DCH for testing & All Select Lab tests must go to Quest. Please alert the front & nursing staff of your insurance.

If a patient is a minor (18 years or younger), the parent or guardian is responsible for any payment due at time of service.

Please understand that both parents are financially responsible for payment on the account under all circumstances.

If your check is returned to Moundville Primary Care Associates unpaid, a $30.00 returned check fee will be assessed in addition to the amount of the returned check. We can only accept cash or credit card payments for the returned check and fee. Both the check amount and fee must be paid together. If left unpaid, your check will be turned over to the Worthless Check Unit for collection.

There is a fee and a 48-hour waiting period for all medical record copies and completion of medical forms. Please do not ask the physician to complete forms in the room or leave them with him. All forms must be reviewed for accuracy and completion and we need to have a copy for your file. Please check with our office staff in advance on the cost(s) of each request. Also, to release any medical records, we must have a release of information signed by the patient or parent/guarantor. Due to HIPAA regulations, when picking up records/information, please bring your Driver's License or ID for verification.

We request a minimum of 24 hours notice if you are unable to make your Routine or Weight Loss scheduled appointment. This allows our staff the opportunity to reschedule your appointment for you as well as to work in patients without a current appointment.

There is a $50.00 No-Show Fee for all Routine/Wellness/Chronic Care/Sick (Walk-In) Appointments that are not cancelled/rescheduled & a $50.00 fee for all Moundville Primary Care Associates appointments that are not cancelled/rescheduled within the requested time..

A 'No-Show' is defined as a patient's failure to cancel/reschedule your appointment at least 24 hours in advance.

We will refill your prescription as soon as we are able but please allow a 48-hour turnaround time. No routine prescriptions will be called in at night or on the weekend. There is a charge for prescriptions that must be printed. Due to HIPAA regulations, when picking up records/information, please bring your Driver's License or ID for verification.

Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing. In these cases, you shouldn't be charged more than your plan's co-payments, coinsurance and/or deductible.

What is "balance billing" (sometimes called "surprise billing")?
When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a co-payment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn't in your health plan's network.

"Out-of-network" describes providers and facilities that haven't signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called "balance billing." This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

"Surprise billing" is an unexpected balance bill. This can happen when you can't control who is involved in your care-like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services
If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan's in-network cost-sharing amount (such as co-payments and coinsurance). You can't be balance billed for these emergency services. This includes services you may get after you're in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center
When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan's in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can't balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can't balance bill you, unless you give written consent and give up your protections.

You're never required to give up your protection from balance billing. You also aren't required to get out-of-network care. You can choose a provider or facility in your plan's network.

When balance billing isn't allowed, you also have the following protections:


You are only responsible for paying your share of the cost (like the co-payments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
Generally, your health plan must:

• Cover emergency services without requiring you to get approval for services in advance (prior authorization).
• Cover emergency services by out-of-network providers.
• Base what you owe the provider or facility (cost-sharing) on what an in-network provider or facility would pay and show that amount in your explanation of benefits.
• Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

1. When a primary service is scheduled at least 3 business days before the date the service is scheduled to be furnished: No later than 1 business day after the date of scheduling;
2. When a primary service is scheduled at least 10 business days before such service is scheduled to be furnished: No later than 3 business days after the date of scheduling; or
3. When a good faith estimate is requested by an uninsured (or self-pay) individual: no later than 3 business days after the date of the requested.