Payment Policy

Thank you for choosing Arkansas Urology as your health care provider. We are committed to building a successful physician-patient relationship with you. Your understanding of and compliance with the financial policy is necessary in facilitating your care. Please ask if you have any questions about our fees, our policies, or your responsibilities. It is your responsibility to notify our office of any patient information changes (i.e., address, name, insurance information, etc.)

Proof of Identity & Insurance

We ask that you present picture identification and your health insurance card(s) at each visit. It is a requirement to correctly identify all patients in our medical record system for your safety and billing purposes. Failure to present picture identification may result in cancellation of your appointment.

Co-pays and Outstanding Balances

As part of our Financial Policy, it is our standard practice to collect the patient’s estimated financial responsibility for all scheduled services, in all locations, prior to services rendered. Patient financial responsibility includes co-pays, co-insurance, unmet deductibles, self-pay estimates, non-covered services, and past due balances; as applicable. All are due at time of Check-in unless prior arrangements have been made with a Financial Counselor. We accept cash, checks, money orders, credit cards, and Care Credit. Your appointment may be rescheduled to a date that is most convenient for you to bring payment at time of service.

If no resolution for payment is made within sixty (60) calendar days, the account balance may be forwarded to a Collection Agency. When this happens, the patient may be held responsible for financial penalties, such as, but not limited to collection and legal fees/interest. Patients who have financial constraints should speak to one of our billing representatives to explore other options. You may call us at (501) 246-3423 to discuss further.

Other Services

Arkansas Urology advises that the possibility exists that you may receive charges in addition to those from our practice. If you are scheduled for an x-ray, laboratory testing, or a procedure requiring anesthesia, etc., there could be fees associated to services not performed or completed by AU. Such fees will be billed to you by the provider of those
services. Arkansas Urology contracts for anesthesia services through Arkansas Anesthesia Associates (501-771-4693) and for radiological interpretation services through Radiology Consultants (501-227-5130). Some insurance plans may pay for these services utilizing your out-of-network benefits. Please contact your insurance company to determine how these services will be paid under your policy before you arrive to your appointment.

Pre-Service Deposits

In most cases, our office will provide a good-faith cost estimate and pre-collect your estimated financial responsibility within seven days prior to surgery. A patient representative will contact you to discuss your plan benefits, estimated costs, and collect your pre-service deposit prior to your scheduled service/ surgery. Surgery may be rescheduled or cancelled if the deposit is not received in our office. For your convenience, our office accepts cash, checks, money orders, and debit/credit cards. Personal checks will not be accepted for Surgery deposits. Payment plans are available in limited circumstances.

Workers’ Compensation and Automobile Accidents

Arkansas Urology provides treatment for patients for work-related injuries and automobile accidents. For a work-related injury, the patient is responsible for providing the name and phone number of your employer and insurance carrier so that we can get approval for your treatment.

For treatment for an automobile accident injury, we understand you may not have complete insurance information at the time of your first visit. However, the patient will be financially responsible for the charges ahead of services rendered. Please contact our Billing Department for further information.

Missed Appointments

If you need to cancel an appointment, we ask for at least 24 hours’ notice. Compliance with your scheduled appointment allows the providers of Arkansas Urology to properly care for patients. Failure to keep your appointments may invoke a Missed Appointment fee of $25.00 per incident.

Minors The parent(s) or guardian(s) are responsible for full payment.

FMLA, Disability, and Other Forms

There is a $25 charge to the patient for the physician and/or nurse’s time associated with completing these forms. This fee is required to be paid in advance of these forms being completed.

Returned Checks

The charge for a returned check is $25.00. This will be applied to your account in addition to the insufficient funds amount. You may be placed on a cash only basis following any returned check.

Attestation Statement:
I have read, understand, and have been allowed to ask questions on the above Patient Financial Policy. I understand that charges not covered by my insurance company, as well as applicable copayments and deductibles, are my responsibility. I acknowledge that these policies do not obligate Arkansas Urology to extend credit. I authorize my insurance benefits be paid directly to Arkansas Urology. I authorize Arkansas Urology to release pertinent medical information to my insurance company when requested, or to facilitate payment of a claim. I agree to comply with the guidelines within.



This financial policy helps the office provide quality care to our patients. If you have any questions or need clarification on the above policies, please contact our Financial Coordinator(s) at (501) 537-7803.

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