MIME-Version: 1.0
Content-Location: file:///C:/A727B0D9/OfficepaymentPolicy.htm
Content-Transfer-Encoding: quoted-printable
Content-Type: text/html; charset="us-ascii"

<html xmlns:o=3D"urn:schemas-microsoft-com:office:office"
xmlns:w=3D"urn:schemas-microsoft-com:office:word"
xmlns=3D"http://www.w3.org/TR/REC-html40">

<head>
<meta http-equiv=3DContent-Type content=3D"text/html; charset=3Dus-ascii">
<meta name=3DProgId content=3DWord.Document>
<meta name=3DGenerator content=3D"Microsoft Word 11">
<meta name=3DOriginator content=3D"Microsoft Word 11">
<link rel=3DFile-List href=3D"OfficepaymentPolicy_files/filelist.xml">
<title>Lone Star Physicians Group, P</title>
<!--[if gte mso 9]><xml>
 <o:DocumentProperties>
  <o:Author> Iresh Kumar</o:Author>
  <o:Template>Normal</o:Template>
  <o:LastAuthor> Iresh Kumar</o:LastAuthor>
  <o:Revision>1</o:Revision>
  <o:TotalTime>3</o:TotalTime>
  <o:Created>2009-12-14T20:57:00Z</o:Created>
  <o:LastSaved>2009-12-14T21:00:00Z</o:LastSaved>
  <o:Pages>1</o:Pages>
  <o:Words>145</o:Words>
  <o:Characters>832</o:Characters>
  <o:Company> Lone Star Physicians Group, P.A.</o:Company>
  <o:Lines>6</o:Lines>
  <o:Paragraphs>1</o:Paragraphs>
  <o:CharactersWithSpaces>976</o:CharactersWithSpaces>
  <o:Version>11.9999</o:Version>
 </o:DocumentProperties>
</xml><![endif]--><!--[if gte mso 9]><xml>
 <w:WordDocument>
  <w:SpellingState>Clean</w:SpellingState>
  <w:GrammarState>Clean</w:GrammarState>
  <w:PunctuationKerning/>
  <w:ValidateAgainstSchemas/>
  <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid>
  <w:IgnoreMixedContent>false</w:IgnoreMixedContent>
  <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText>
  <w:Compatibility>
   <w:BreakWrappedTables/>
   <w:SnapToGridInCell/>
   <w:WrapTextWithPunct/>
   <w:UseAsianBreakRules/>
   <w:DontGrowAutofit/>
  </w:Compatibility>
  <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel>
 </w:WordDocument>
</xml><![endif]--><!--[if gte mso 9]><xml>
 <w:LatentStyles DefLockedState=3D"false" LatentStyleCount=3D"156">
 </w:LatentStyles>
</xml><![endif]-->
<style>
<!--
 /* Font Definitions */
 @font-face
	{font-family:Garamond;
	panose-1:2 2 4 4 3 3 1 1 8 3;
	mso-font-charset:0;
	mso-generic-font-family:roman;
	mso-font-pitch:variable;
	mso-font-signature:647 0 0 0 159 0;}
 /* Style Definitions */
 p.MsoNormal, li.MsoNormal, div.MsoNormal
	{mso-style-parent:"";
	margin:0in;
	margin-bottom:.0001pt;
	mso-pagination:widow-orphan;
	font-size:12.0pt;
	font-family:"Times New Roman";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
h2
	{mso-style-next:"Body Text";
	margin-top:0in;
	margin-right:0in;
	margin-bottom:3.0pt;
	margin-left:0in;
	line-height:12.0pt;
	mso-line-height-rule:exactly;
	mso-pagination:widow-orphan lines-together;
	page-break-after:avoid;
	mso-outline-level:2;
	border:none;
	mso-border-bottom-alt:solid windowtext .75pt;
	padding:0in;
	mso-padding-alt:0in 0in 1.0pt 0in;
	font-size:14.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:Garamond;
	text-transform:uppercase;
	letter-spacing:-.25pt;
	mso-font-kerning:14.0pt;
	mso-fareast-language:EN-US;
	font-weight:normal;}
p.MsoBodyText, li.MsoBodyText, div.MsoBodyText
	{margin-top:0in;
	margin-right:0in;
	margin-bottom:6.0pt;
	margin-left:0in;
	mso-pagination:widow-orphan;
	font-size:12.0pt;
	font-family:"Times New Roman";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
p.BlockQuotation, li.BlockQuotation, div.BlockQuotation
	{mso-style-name:"Block Quotation";
	mso-style-parent:"Body Text";
	margin-top:0in;
	margin-right:12.0pt;
	margin-bottom:12.0pt;
	margin-left:12.0pt;
	mso-line-height-alt:10.0pt;
	mso-pagination:widow-orphan lines-together;
	background:#F2F2F2;
	mso-shading:windowtext;
	mso-pattern:gray-5 auto;
	border:none;
	mso-border-alt:solid white .75pt;
	padding:0in;
	mso-padding-alt:12.0pt 12.0pt 12.0pt 12.0pt;
	font-size:13.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:Garamond;
	mso-fareast-font-family:"Times New Roman";
	mso-bidi-font-family:"Times New Roman";
	letter-spacing:-.25pt;
	mso-fareast-language:EN-US;
	font-style:italic;
	mso-bidi-font-style:normal;}
@page Section1
	{size:8.5in 11.0in;
	margin:1.0in 1.25in 1.0in 1.25in;
	mso-header-margin:.5in;
	mso-footer-margin:.5in;
	mso-paper-source:0;}
div.Section1
	{page:Section1;}
-->
</style>
<!--[if gte mso 10]>
<style>
 /* Style Definitions */
 table.MsoNormalTable
	{mso-style-name:"Table Normal";
	mso-tstyle-rowband-size:0;
	mso-tstyle-colband-size:0;
	mso-style-noshow:yes;
	mso-style-parent:"";
	mso-padding-alt:0in 5.4pt 0in 5.4pt;
	mso-para-margin:0in;
	mso-para-margin-bottom:.0001pt;
	mso-pagination:widow-orphan;
	font-size:10.0pt;
	font-family:"Times New Roman";
	mso-ansi-language:#0400;
	mso-fareast-language:#0400;
	mso-bidi-language:#0400;}
</style>
<![endif]-->
</head>

<body lang=3DEN-US style=3D'tab-interval:.5in'>

<div class=3DSection1>

<div style=3D'mso-element:para-border-div;border:solid white 1.0pt;mso-bord=
er-alt:
solid white .75pt;padding:12.0pt 12.0pt 12.0pt 12.0pt;background:#F2F2F2;
mso-shading:windowtext;mso-pattern:gray-5 auto'>

<p class=3DBlockQuotation align=3Dcenter style=3D'margin-top:0in;margin-rig=
ht:0in;
margin-bottom:12.0pt;margin-left:0in;text-align:center;background:#F2F2F2;
mso-shading:windowtext;mso-pattern:gray-5 auto'><b><u><span style=3D'font-s=
ize:
12.0pt;font-style:normal'>Lone Star Physicians Group, P.A.<o:p></o:p></span=
></u></b></p>

<p class=3DBlockQuotation style=3D'margin-top:0in;margin-right:0in;margin-b=
ottom:
12.0pt;margin-left:0in;background:#F2F2F2;mso-shading:windowtext;mso-patter=
n:
gray-5 auto'><b><u><span style=3D'font-size:12.0pt;font-style:normal'><o:p>=
<span
 style=3D'text-decoration:none'>&nbsp;</span></o:p></span></u></b></p>

<p class=3DBlockQuotation style=3D'margin-top:0in;margin-right:0in;margin-b=
ottom:
12.0pt;margin-left:0in;background:#F2F2F2;mso-shading:windowtext;mso-patter=
n:
gray-5 auto'><b><u><span style=3D'font-size:12.0pt;font-style:normal'>Payme=
nt
policy</span></u></b><span style=3D'font-size:12.0pt;font-style:normal'>:<o=
:p></o:p></span></p>

<p class=3DBlockQuotation style=3D'margin-top:0in;margin-right:0in;margin-b=
ottom:
12.0pt;margin-left:0in;background:#F2F2F2;mso-shading:windowtext;mso-patter=
n:
gray-5 auto'><span style=3D'font-size:12.0pt;font-style:normal'>All payments
including the co-pays, co-insurance, non covered services, self insured
payments are payable at the time of service, unless a prior arrangement has
been made regarding the payments (only for established patients). It is your
responsibility to confirm if the services are covered under your insurance =
plan
ahead of the visit. There is a discount available for self insured patients=
 who
make prompt payments on the day of service. <o:p></o:p></span></p>

</div>

<h2 style=3D'border:none;mso-padding-alt:0in 0in 0in 0in'><span style=3D'fo=
nt-size:
12.0pt;text-transform:none'>We will bill your insurance company for the
services rendered. Accounts that are 30 days past due will be contacted for
payment and accounts that are 90 days past due will be forwarded to
collections. <span style=3D'mso-spacerun:yes'>&nbsp;</span><o:p></o:p></spa=
n></h2>

<div style=3D'mso-element:para-border-div;border:none;border-bottom:solid w=
indowtext 1.0pt;
mso-border-bottom-alt:solid windowtext .75pt;padding:0in 0in 1.0pt 0in'>

<h2><span style=3D'font-size:12.0pt;text-transform:none'>As a convenience t=
o our
patients we accept credit cards (Visa, MasterCard, American Express and
Discover) and debit cards. Personal Checks are accepted and returned checks
will be charged $30.00 in addition to fees that may be charged by other
institutions. <o:p></o:p></span></h2>

</div>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal>Dr. Kumar and Staff.</p>

</div>

</body>

</html>
