Dear Patient:

Welcome to Cottonwood Medical Center Ltd. We are pleased that you have chosen us as your providers. We would like to familiarize you with how our services are billed. Because we believe the best services are possible if there is a friendly, mutual understanding between patient and provider, we ask that you take the time to read our policy thoroughly so that we can avoid any misunderstandings. If you have any questions or concerns, our patient account representative would be happy to discuss them with you.

Cottonwood Medical Center Ltd participates in many but not all insurance programs. We will file your insurance claims for you if you are enrolled in one of these plans. Please note: Co-pays, deductibles & co-insurance amounts are to be paid at the time of service.  Even though we participate with your insurance, some charges may nonetheless, be your responsibility and it is always your responsibility to secure appropriate authorization if your plan requires it. We do not see patients for Workman’s Compensation injuries.

For our patients who are not covered under insurance plans we participate with, we require full payment at the time of service. We will provide you with a statement when you leave our office, which you can use to bill your insurance company. This includes office visits related to motor vehicle accidents. 

Collection Policy: We request full payment at time of service. Payment on your balance is due within 30 days of the receipt of your billing statement. If a patient fails to pay for services within a reasonable amount of time or fails to cooperate with the terms of an agreed upon payment schedule, we will turn your account over to a collection agency or take legal action. The patient will be responsible for all charges incurred by this office in the collection of their bill.

Insurance Information: When we are notified by your insurance company that they have requested information from you for example: (primary insurance info, pre-existing, student verification, accident details) these charges will be automatically dropped to your responsibility and you will be asked to pay the balance in full. If you need assistance with a form, please call us, or bring in your form and we can help you complete the form and fax the form back to your insurance company.

Form Completion:  In the event you will need any forms filled out, for example, FMLA and Disability, there is a $50.00 charge for each form, payable prior to the preparation and release of the information. 

Hospitalization:  In the event of hospitalization, the Cottonwood physicians are no longer attending their patients at Banner CG and thus the hospitalists will take over your care until you are released. At that time you will be returned to the Cottonwood providers for continuity of care.  You always have the option to select another hospital in the Phoenix or Tucson area should you decide not to be admitted to the local hospital.  Please bring your discharge paperwork with you upon your return to the practice for your hospital follow up visit. 

Missed Appointment Policy:  Patients will be billed $50.00 for each missed appointment. To avoid this charge please call and cancel your scheduled appointment, preferably 24 hours in advance.

Finance Charges: We assess a finance charge on all delinquent balances. The finance charge is computed on a periodic rate of 1 ½ % per month (18% per year). The periodic rate is applied to all balances over 60 days.

Credit Policy: Under rare circumstances, such as cases of hardship, we may agree to set up a payment schedule with you to pay your balance in equal monthly installments. All payment plans are on a case-by-case basis; you will need to meet with our patient account representative to discuss our payment plan in detail.

Return Check Policy: When checks are returned by the bank due to insufficient funds, your account will be charged a $15.00 non-sufficient check fee.

Please feel free to call our office if any of your concerns or questions has not been addressed. The number is (520) 836-5538 or the toll free number 1-800-895-5538.


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Cottonwood Medical Center, Ltd. is dedicated to 
providing excellence in all areas of patient care, 
to foster the highest levels of academic and 
clinical development of its providers, and to 
provide strong leadership in the development, 
growth, and direction of health care in our 

Cottonwood Medical Center, LTD.
Tel: (520) 836-5538 Fax: (520) 876-0878
Toll Free: (800) 895-5538