My staff and I are here to serve your healthcare needs and are dedicated to providing you the best care possible. It is important that you understand that For Women By Women puts you, and not your insurance company in charge of your healthcare. If you have any questions regarding our billing policies please be sure to ask on your office visit.

BILLING: Cash pay patients receive a 20% discount from our normal fee schedule. Discounted fee schedule does not apply to lazer or cosmetic treatments.

Co-pays are due at each visit and will be collected when you check in. For your convenience we accept payments by cash, check, Visa and MasterCard.

ACCOUNT FEES: Past due patient balances and unpaid co-payments may incur the greater of a $20.00 billing charge per month or interest at an annual rate of 18%. A fee of $25.00 will be charged for each returned check.

RECORDS & FORMS: The completion of the physician section of disability forms will incur a $20.00 administrative charge. Duplication of medical records is $30.00 - $50.00.

PATIENT INFORMATION: You will be asked to fill out a patient information form at your initial visit (or see below to download and fill out today) and each year thereafter. In order to keep your file up to date, please inform us of any changes of information such as insurance, address and telephone number.

MISSED APPOINTMENTS: Unless canceled 24 hours in advance, you may be charged $50.00 for a missed appointment. Please help us serve our patients better by keeping scheduled appointments.

A. Privacy (HIPAA)
Click here to download a pdf of the HIPAA Privacy information

B. New Patient Form
Dr. Mayhew welcomes new patients and will do an initial physical examination, along with a patient interview. New patients may download the new patient form and complete this prior to the first visit to expedite the appointment. Dr. Mayhew welcomes referrals, and encourages mothers of daughters to bring them in at the onset of puberty.

C. INSURANCE:
Insurance policy provisions have for some time, dictated what services can be provided, the timing of those services and the reimbursement rate for services. Not only have these provisions adversely impacted the quality of care, they have also reduced the doctor patient relationship to an occasional brief encounter. We feel our patients deserve better.

Your individual insurance plan is an agreement between you and your insurance company. It is your responsibility to know the specific details of your own plan and it is especially important for you to notify us if there are restrictions regarding referrals, labs, or services to be performed by outside facilities or specialists. You may be responsible for charges if they are not contracted with your insurance company or you have not received proper pre-authorization. You will also be responsible for any, “Non-Covered Services”.

Our office contracts with very few insurance companies. If we are contracted as preferred providers with your health plan, we will bill your insurance company directly; otherwise, your account will be considered a cash account with full payment expected at the time of service. You will be provided with the documentation necessary to bill your insurance company at the time of service. At the present time we are contracted with only the following plans:

• First Health Network/Coventry Health Care
• Cigna PPO