Financial Policy

Fatima Noorani, MD-Psychiatry, PLLC must be in network with your insurance company for your plan to cover visits. If your insurance company requires a Referral or a Prior Authorization before receiving services at Fatima Noorani, MD-Psychiatry, PLLC, it is your responsibility to comply with this requirement before receiving services at our office.

TERMS OF FINANCIAL AGREEMENT:

§ If my insurance is in network with Fatima Noorani, MD-Psychiatry, PLLC, I understand that it is my responsibility to provide the most current insurance card and information.

§ It is my responsibility to confirm with my insurance company the percent and amount that will be covered for visits.

§ I understand that it is my responsibility to consult with my insurance company regarding my benefit plan to determine if I need a Referral or a Prior Authorization before receiving services at Fatima Noorani, MD-Psychiatry, PLLC.

§ I understand that it is my responsibility to notify Fatima Noorani, MD-Psychiatry, PLLC, if I have Medicare and to sign the “Opt Out Form”.

§ I understand that a Referral or a Prior Authorization provided by my insurance company is not a guarantee of payment and in the event that my insurance company later rejects or denies the Referral or Prior Authorization for services rendered that the amount dues is my patient responsibility.

§ I understand that Late Cancellation (<48 hours)/Missed Appointment Fees and other services that are NOT COVERED BY INSURANCE will be charged to my account as my patient responsibility.

§ I understand that all services rejected or denied by my insurance company as non-covered will become my patient responsibility.

§ I understand once my insurance had paid the portion for the visit as shown on my Explanation of Benefits (EOB), which is provided to me by my insurance company, that the remaining balance becomes my patient responsibility.

§ I understand that if my account becomes 90 days overdue, full payment will be collected by Fatima Noorani, MD for each visit until the payment is full. § I understand that Patient Responsibility means that amount in my account that is owed to Fatima Noorani, MD-Psychiatry, PLLC.