Keystone Urology accepts insurance from most major insurance companies. All services provided are the patient’s responsibility. As a courtesy, we will file claims with your insurance carriers provided we are supplied with your current insurance information. A copy of your insurance card and prescription card will be made at the time of your visit. If your insurance requires a referral or authorization from your primary care physician, you should present the form at check-in. Failure to provide us with a referral or authorization will result in your appointment being rescheduled.

Your insurance coverage is a contract between you and your insurance carrier. Keystone Urology participates with most insurance carriers and we will endeavor to assist you in filing your claim and receiving payment from your insurance carrier. You should check with your insurance carrier to see if they participate with our practice or if you need a referral or authorization to be seen by one of our providers. Your insurance carrier requires us to collect copayments, deductible and co-insurance amounts. Deductibles and co-insurance amounts are collected prior to procedure scheduling. We collect copayments at the time of service. Your co-pay amount should be listed on your insurance card. We accept Mastercard, VISA, Discover, and American Express, cash or personal checks. We provide financial counseling if necessary.

Please contact your insurance carrier to verify your benefits as some preventive procedures and wellness visits may not be covered. All labs or imaging studies should be verified with your insurance carrier for the correct location or your insurance may not pay for services. Please inform us if your insurance carrier has a designated lab or imaging facility. If your insurance requires pre-certification, please inform our staff so we may assist you in this process. Failure to obtain pre-certification or authorization at the correct facility will result in the entire balance being the patient’s responsibility.

When you have a procedure performed by one of our physicians, you will receive:

  1. A bill for our physician performing the service
  2. A bill for pathology services If a tissue specimen is taken during your procedure – this bill may be from our office or from another institution depending on your insurance coverage
  3. A bill from the radiologist for reading your CT scan if one is done
  4. A separate bill from another facility for surgery being performed
  5. A separate bill from the anesthesiologist if anesthesia is required for your procedure.

All procedures are scheduled in advance. If you must cancel a procedure or office visit, kindly give 24 hours’ notice so another patient can utilize your appointment slot. If you fail to notify us, a $25.00 fee will be charged. Continued cancellation of appointments will result in additional fees and may result in dismissal from the practice.

Each month you will receive a statement for services, which is due and payable within 30 days. If payment is late or you have not previously made financial arrangements, a reminder notice will be sent. In the event your account remains unpaid, Lancaster urology may turn the account over to collections. By signing this Financial Policy, you: 1) agree to pay Lancaster Urology reasonable collection costs as allowed by the laws of the Commonwealth of Pennsylvania 2) agree you will be responsible for any and all costs associated with the collection of your account, including any reasonable attorneys’ fees.

In the event that any monies paid by you result in an overpayment of $25.00 or less, those monies will be applied first to any previous balance and will remain on your account as a credit for a future visit unless you request a refund.

I have read and fully understand the financial policy set forth by Keystone Urology and I agree to the terms of this policy. I also understand and agree that the terms of this financial policy may be amended by the practice any time without prior notification.