Billing Policies

All co-payments are expected at the time of service. For your convenience, accepts cash, personal, and Visa/MasterCard / American Express/Discover debit and credit cards. Surcharges will be assessed for returned checks or co-payments not made at the time of service. You may elect to complete a credit card authorization form which will allow for your credit card to be charged at every visit. This can be used to pay for your co-payments, forms, or non-covered services.

Our contracts with insurance companies require that we verify your current coverage and collect your co-payment at each visit. Please bring your insurance card to every appointment.

Fees for Non-Covered Services

The following fees will be charged for services that are not covered by insurance. These charges and policies are described in full detail below:

Service Fees
Missed well appointments (if not canceled 24 hours prior) $50-100
Returned check  $35

Patient Financial Responsibility Statement

At the time of your first visit, you will be asked to read the following Financial Policy and sign that you acknowledge and accept our policy. This policy may be revised from time to time. We will always post the most recent version of the policy on this page of our web site.

Insurance Coverage

You must provide your insurance card or proof of insurance at the time of each visit. If you do not have insurance, are unable to provide proof of insurance, or are on a plan in which we do not participate, full payment is required at the time of your visit.

It is very important that you become familiar with your insurance plans and understand its benefits. Certain plans have restrictions on certain services such as s. It is your responsibility to be aware and understand your plan’s restrictions and limitations. Individual employers can modify plans. Insurance companies usually do not make information available to us about specific peculiarities of your health plan. (There are many of them.) If you have any questions regarding your coverage, health benefits, health restrictions, and payment determination then you need to contact your insurance company directly.

Payment Methods

All co-payments and deductibles are due at the time of service. These fees by law cannot be waived. For your convenience, we accept cash, ATM cards, Visa, MasterCard, American Express, and Discover Cards.


RAMIN AHMADI MD. will bill insurance companies for which we are providers as Medical AHMADI, MD. You will be responsible for all co-pays and co-insurance at the time of services. Some of the services provided may be non-covered services and not paid by your insurance company. You are personally responsible for these services. You will receive a bill, which must be paid upon receipt. If you have a deductible, you will be required to pay the uncovered amount at the time of your visit. If you are overcharged at the time of your visit and pay by credit card, you will have any overpayment reimbursed promptly.

If we are not a provider on your current plan or do not have proof of insurance then you will be responsible for the entire bill at the time of service.

We will provide you with an encounter form at each visit so that you can file the claim with your insurance company.

Unpaid Balance

Unpaid fees in excess of 90 days will be subject to referral to a collection agency. This may affect your credit rating.

Medical Records

You may request copies of your records writing by mail or fax. This is a legal requirement. We will provide copies of the required medical records to specialists free of charge. Please allow us 7 days to complete this request.


If your insurance plan requires a referral prior to seeing a specialist or using a hospital service then we will need greater than 24 hours notice. A referral issued after the service is provided may result in a denial of coverage for that visit. It is your responsibility to know your insurance company requirements. We do not have access to that information many times.

Missed Appointments/Cancelled Appointments

Missed appointments for comprehensive/preventive visits (checkups) are scheduled for 30 minutes and are a substantial commitment of time on our part. If a patient does not show up for the appointment and we have no ability to substitute another patient for this time, it costs the practice a substantial amount of lost revenue.

Our policy requires that you notify us 24 hours in advance if you will not be able to keep your appointment. If you do not notify us of your inability to keep your appointment we will charge a fee. That fee will be $50 for the first missed appointment and $100 for any subsequent appointments for all patients who are not in federal/state-funded insurance plans.

Please do not try to renegotiate this policy with staff or providers. It is a fixed, non-negotiable policy.

Delinquent Accounts

Payment can be arranged with our business office for past due amounts. Failure to pay or arrange payment of a past due amount within 90 days will result in a referral to a collection agency. If this occurs then you will be responsible for all reasonable attorney fees, court costs, and collection fees related to the delinquent account. Credit reporting is done by our collection agency and this may affect your credit rating.