Our Office

Forms & Policies

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Patient Forms

Office Policies

Lab Tests. We will draw your labs here on site and send them to the laboratory for testing. If you have Aetna Insurance or Medical Mutual Of Ohio, we will send your tests to Ohio Health. All other tests will be sent to LabCorp. If you had a pap smear and it was sent to LabCorp, you can call them for your results. Our check out desk will give you a card upon leaving with a number to call. We will call you with all abnormal results. If we do not reach you after 2 telephone attempts we will send you a letter.

Financial Policy

Co-payments are due at the time of service. If you do not have your co-payment or your insurance information with you at the time of your appointment, you will be rescheduled.

Discounts are given to patients with no insurance if payment is made on the day of your appointment. If you do not pay in full, then you will not qualify for the prompt pay discount.

Annuals. Most insurance companies pay for one annual in a 12 month period. Check with your insurance company prior to your appointment to see if your insurance company requires a co-payment on yearly well woman visits. If you have a problem at the time of your annual visit, you may be asked to reschedule your visit. If both a problem and an annual are taken care of at the same visit, your insurance company will be billed for both, so you may have some extra expenses.

Lab work. We will send your lab work to LabCorp or Ohio Health, depending on your insurance. You will be billed directly by the lab for any tests that we order. If you have questions regarding a bill that you received from a lab, please contact the lab directly.

Surgeries. The specialist that schedules your surgery will check with your insurance company for coverage on the procedure you are having done. We will estimate how much your surgery will cost and what your responsibility will be. A deposit is required prior to surgery as well as a payment agreement for any remaining patient balance. Checking your benefits does not guarantee payment. The patient is ultimately responsible for payment. If your insurance company does not pay within a reasonable time, you will be billed for services.

In Office Procedures. Prior to being scheduled for an office procedure, we will check with your insurance company for coverage. If you do not have coverage, the procedure must be paid for at the time of service, unless specific arrangements have been made with the billing manager. Payments for an IUD and Implanon MUST be submitted at the time of service and are not discounted under the prompt payment fee schedule.

Maternity. After your first OB visit, we will contact your insurance company and verify your benefits. Routine office visits are included with the delivery. Ultrasounds, Non-stress tests, Lab, Facility Fees, and non-pregnancy related office visits are billed separately and will require separate co payments, deductibles and/or co-insurance amounts. We will estimate how much you will owe for the delivery only. This amount is expected to be paid by week 32 of your pregnancy. You can pay it all at once or make payments. Any amounts for non-included services will be billed to you separately. We will reimburse you for any over payment that we may have received within 30 days of receipt of payment from your insurance company.

Convenient Automatic Payment Plans: We also offer prompt pay discounts to patients who sign up for our automatic payment plan. This plan requires a pin-less debit check card or a credit card. We automatically charge prearranged payments to your card monthly.

If you have questions regarding your bill, please email us at: billing@cwc4women.com