Financial & Credit Policy

Financial Policy

If I am not using insurance, I will pay for all charges in full today according to the Self-Pay Pricing schedule available in the clinic.   If I am using insurance, I agree to pay today, at the time of service, my urgent care benefits, copays, coinsurance and deductibles.  If I have an insurance deductible that has not been met, I agree to pay in full at the time of service.  If paying with credit, I understand and agree that card info may be ‘stored on file’ and charged, with my permission, for any patient liability amounts incurred today or in the future, after my claim is processed by insurance.  I will receive an EOB (Explanation of Benefits) from my insurance company after each visit and I agree to pay any amounts indicated on the EOB as patient liability amounts.  I will receive a bill from CityDoc regarding these amounts and agree to pay upon receipt of the bill.  I further understand that should my account become delinquent, it may be turned over to a collection agency with additional collection and/or attorney fees.

Assignment of Insurance Benefits

CityDoc is contracted with some insurance plans, but not all.  If contracted with your insurance, we will file a claim with the payer indicated on your current-active health insurance ID card.  CityDoc is an urgent care provider with insurance plans, therefore, urgent care benefits, copays, coinsurance, and deductibles are due by the patient at the time of service.   I authorize CityDoc to bill my medical insurance and to release any information the insurance carrier requires to process the claim.  I do hereby assign payment directly to CityDoc Urgent Care for medical benefits for professional services rendered.  I will present my current-active insurance ID card and picture ID on each visit.  I will update CityDoc on any changes in insurance coverage since my last visit.


Your insurance plan may require a referral from your PCP or require some other information from you to process your claim for an urgent care visit.   It is the patient’s responsibility to ensure referrals are obtained and your insurance carrier’s rules regarding authorizations for urgent care visits are followed.  In the event your insurance company determines your visit is not covered, not authorized, and/or needs additional info from you without obtaining it, and insurance denies payment for the claim, you will be responsible for payment of the claim as indicated on the insurance EOB.

HIPPA Notice of Privacy Practices

The Health Insurance Portability and Accountability Act (HIPPA) is a federal government regulation designed to ensure that you are aware of your privacy rights and of how your medical information can be used by CityDoc.  I acknowledge that I have received and read a copy of CityDoc’s Notice of Privacy Practices.


Payment Guidelines

At CityDoc Urgent Care, our goal is to streamline your visit, focusing on convenience and efficiency. Below are our established guidelines for payments to facilitate a smooth billing experience.

Credit Card Authorization and Policy

CityDoc Urgent Care requests a Credit Card Authorization for most patients as a safeguard for any additional charges that may arise post-insurance coverage. This process, termed “Credit Authorization,” ensures efficient billing and collection for services provided, necessitating most patients to have a credit card authorized at the clinic prior to receiving services. 

Credit Authorization Process:

Co-payments are collected as usual during each visit, and we handle all insurance claims on your behalf. We do not accept all insurance ID cards. Please refer to our Insurances Accepted page.

Following insurance processing, patients receive an Explanation of Benefits (EOB) detailing their share of the cost, which we also receive. After our billing team processes your claim, you’ll receive an alert in the next billing cycle, which will specify the amount to be charged to your card within 7 days of the auto-collection date.

Should the EOB show no balance due, we will not charge your card.

FAQs Regarding Credit Authorization:

Why this policy?
The shifting dynamics of health insurance increasingly place financial responsibility on patients. Our policy aims to ease this burden, enhancing patient experience and allowing us to prioritize high-quality care.

How is my card information secured?
Adhering to HIPAA and PCI standards, we ensure your card and personal health information are securely stored on a protected server, meeting all regulatory requirements without local storage.

What charges will apply to my card?
Your card will be charged as per the EOB amount, minus any payments already made, including co-payments. If your insurance covers the full amount, no charge will be made.

Understanding Deductibles:

A deductible is an out-of-pocket expense threshold you must meet before insurance coverage kicks in, impacting your direct costs.

Checking Deductible Status:

You can inquire about your deductible status with your insurance provider or check online where available.

Alternative Payment Methods:

Besides credit cards, we accept payments via HSA, HRA, FSA, and debit cards.