Billing and Payments

  • All copays and outstanding balances are due at the time of your visit. If you are unable to pay your copay and/or your balance at the time of your visit, you may be asked to reschedule.
  • If you have a HSA / FSA (Health Savings or Flex Spending Account) or insurance plan with a deductible, you are required to pay for our services at the time of your visit.
  • Our office bills your insurance company as a courtesy.  If your insurance does not pay for your visit, you will be financially responsible for payment.  Because insurance companies often change benefits and guidelines, it is in your best interest to check with your insurance ahead of time to see if your visit will be covered.
  • The bank charges our office a $25.00 fee for all uncleared/returned checks.  This charge will be passed on to you in addition to the value of your check in the case that this circumstance arises.  If we receive a returned check from your account you will no longer be able to pay with personal check and a complaint form will be submitted to the prosecuting attorney’s office.

Forms of Payment Accepted: Cash and Personal Check

 

 

Billing / Payments Contact Form

Your Name (required):

Your Email (required):

Primary Telephone: (required):

Secondary Telephone:

DOB (date of birth) (required):

SSN#:

Insurance Carrier (required):

Insurance Group #:

Insurance Member ID#:

Your Message

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Michael Burks, M.D.,FACOG – Obstetrician / Gynecologist, Columbia, MO