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 Fee For Service
 Print Friendly Fee For Service Letter Contact Us

Dear Patient:

Six years ago, we instituted an Administrative Services Program that allowed our patients to elect whether to pay a yearly fee covering non-covered medical services (as defined by health benefit plans in which our practice participates) such as letters, forms, disability and leave of absence forms and missed appointment fees, as well as some prescription services such as chronic illness care refill services, or to pay in advance for each non-covered service if and when a patient requested the service.
We did this in order to streamline our operations for our patients, and offer patients an affordable way to defray the cost for non-covered services. We are pleased to report that most of our patients elected to enroll in the Administrative Services Program.
Through the years, we have learned that we canít offer these features on a pay-as-you-go basis: there is no practical way for us to exclude patients who donít want to participate in the Administrative Services Program.
Since most of our patients had enrolled in the Administrative Services Program in the past, beginning last year, we required all of our patients to enroll in the Administrative Services Program in order to remain patients of our practice. We are going to continue with this policy for 2010. The fee for 2010 will remain the same at $50 per individual, or $95 per family, and the fee is due by March 31, 2010. If this nominal fee is a financial hardship, please call our office manager to help accommodate you and your family.

If you wish to continue in the Administrative Services Program and continue as a patient of our office, please sign below that you have read and agreed to the information in this letter, and please return the signed agreement with payment by March 31, 2010. After April 1, 2010, we will not be able to accept appointments for you or your family members if you are not covered by the Administrative Services Program.


Albert J. Weisbrot, M.D.
Faye Y. Lang, M.D.
Robyn H. Suna, M.D.
Sonali Chokshi, M.D.

Albert J. Weisbrot, M.D. and Associates, Inc.
7451 Mason Montgomery Rd.
Mason Ohio 45040
Phone: 513-770-0330
Fax: 513-770-2106

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Copyright © 2008 Albert J. Weisbrot, M.D. and Associates, Inc.
Last modified: 08/23/10