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CHI Health Clinic Billing

Patient Financial Responsibility

Insurance (in-network)

We will submit insurance claims according to the terms of the individual insurance company contracts. Applicable copays, co-insurance, deductibles and non-covered services are due at the time of service. If your copay is not paid at the time of service, your visit may be rescheduled. We are required by our insurance contact to collect your copay.

Insurance (out-of-network)

If your insurance plan is not under contract with CHI Health, we will submit a claim to your insurance company as a courtesy to you. If we have not heard from your insurance company after 60 days, the balance will become your responsibility.


CHI Health Clinic providers accept Medicare assignment. By accepting assignment, we agree to accept Medicare’s “approved amount” as payment for covered services. You are responsible for any remaining balances. As a courtesy to you we will file your secondary insurance plan.

Medicare ABN Form

If you receive a service that may not be considered medically necessary by Medicare, you will be advised by the clinic staff and asked to sign an Advanced Beneficiary Notice (ABN). Medicare’s determination that a service is not medically necessary does not mean that the service should not be provided to you. Your physician will seek necessary services based on your current health condition and his/her expert medical opinion. The ABN Form is your advance notification that the service(s) may not be covered, and you may be financially responsible. At that time, it becomes your decision whether or not to proceed with the test or treatment.

Medicare HMO

If you are a Medicare recipient who has chosen coverage under a Medicare HMO, please be aware of your benefits and any payer restrictions. Certain plans require you to seek treatment from an in-network provider. Copays are due at the time of service or your visit may be rescheduled. You are responsible for any remaining balances.


We will verify Medicaid eligibility at each visit. Please have your current Medicaid card available. To receive coverage benefits, you must seek treatment from your assigned provider, if applicable. If you are ineligible for coverage, your coverage is pending, or you have not qualified for financial assistance you will be expected to pay a deposit of $100 at the time of service.

Workers’ Compensation

When you have an on-the-job injury, worker’s compensation coverage may be liable. Before services are rendered, you will be asked to complete a work injury form. Your employer will be contacted to verify your employment and work related injury. You will be responsible for any services not covered under Workers' Compensation.

Worker’s Compensation. Accident Claims (Not work related)

If you have an accident requiring a claim to a third-party liability company, we will send a claim and then bill you in 45 days if we haven’t received the insurance payment. We will file the charges with your medical insurance at your request or if required by contract.

Additional Health Insurance

Secondary insurance is a health plan that pays costs not covered by primary coverage under coordination of benefits rules. We will file secondary insurance claims as a courtesy to you. If the insurance company does not pay within 60 days following the submission of your secondary claim, you are responsible for the remaining balance.


If you have an insurance plan that requires a referral from your primary care physician prior to a visit to a specialist, it is your responsibility to obtain the referral. If you choose to seek the services of a specialist without the referral, you will be responsible for the payment of the charges.

Self-pay/No Insurance

If you have no insurance, you will be asked to make a $100 deposit at check-in or your visit may be rescheduled. At the conclusion of your visit, you will be asked to pay the balance of your charges. You will receive a 10% discount for payment in full on the day of your visit.

Financial Assistance

CHI Health Clinic offers a financial assistance program on a sliding income scale basis. The program assists uninsured patients as well as those with balances after insurance. Pick up a brochure at your clinic or call the Customer Service Center.

Patient Statements

A patient statement will be mailed to you if a balance is due from you on your account. Payment is expected upon receipt of your statement. Questions or concerns regarding your statement should be directed to the Customer Service Center as soon as possible to avoid unnecessary delays or further collection action on your account.

Payment Arrangements

If you are unable to pay for your patient statement balance in full upon receipt of your statement, please contact the Customer Service Center to discuss payment options. Unless you make payment arrangements, you will be expected to pay your balance by your next office visit.

Unpaid Accounts

Unpaid personal balances will be forwarded to our collection agency. Once an account has been referred to a collection agency, you must work directly with them to satisfy your debt. Patients/families may be dismissed from our practice for non-payment. To help minimize the rising cost of health care, we would appreciate prompt settlement of your medical bills. We also accept cash, checks and all major credit cards. There is a fee for returned checks.

CHI Health Clinic Customer Service Center
Our hours are:
Monday - Friday, 8:00 a.m. to 5:00 p.m.
Toll Free: (855) 515-9372
Contact the Billing Department