Welcome to Oklahoma Oncology. The purpose of this information sheet is to help acquaint you with the services and the financial policies of Oklahoma Oncology. Our Business Office phone number is 918-556-7130.

• As a service to all of our patients, we will file medical insurance claim forms with your insurance carrier or Medicare. To help us better serve you, it is important that your insurance information is accurate. Please notify our business office if your benefits change or if you change insurance carriers.
• Medicare Patients: The physicians of Oklahoma Oncology are proud to be "Participating Providers" of medical services under the Medicare program. As Participating Providers, we agree to accept an amount of payment equal to the Medicare "allowable" for covered services. Medicare pays 80% of the allowable, and the patient, or the patient's secondary insurance, is responsible for paying the remaining 20% of the allowable and any deductibles.
• Please be prepared to make a co-payment at the time of your visit as required by your insurance plan. If you are not prepared to pay at the time of your visit, your appointment may be rescheduled.
• You will receive a statement for any balances due after insurance payments have been applied.
• Our business office staff can help you arrange a fair monthly payment schedule for balances not paid by your insurance company. We accept VISA, MASTERCARD, and DISCOVER.
• There will be a $25.00 service charge for all returned checks. Future appointments will require cash payments.
• There will be a $25.00 charge for completion of all forms processed by our office at the patient's request.

"I hereby assign all medical and/or surgical benefits to Oklahoma Oncology. This assignment will remain in effect until revoked by me in writing. A photocopy of this assignment is to be considered as valid as an original. I understand that I am financially responsible for all charges whether or not paid by my insurance. I hereby authorize Oklahoma Oncology to release all information necessary to secure payment."

Oklahoma law requires that Oklahoma Oncology advise you that the information authorized for release may include records which may indicate the presence of a communicable or non-communicable disease and that you have or have been treated for psychological or psychiatric conditions or substance abuse.