Policies / Insurance / Forms
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Office Policies
CMG strives to provide the best possible care in the most efficient manner while keeping healthcare costs down for all of our patients. As such, certain guidelines are necessary as well as fees for additional services provided to you and your family.
| Category | Process | Additional Fees |
| Scheduled Appointments | All appointments should be made in advance of your arrival to the office – including sick visits. Late arrivals will be seen as time permits, however, it may be necessary to reschedule. | Aside from standard charge for services rendered, no fees |
| Walk-ins | Time permitting; fee required if no appointment was made in advance of your arrival or if you desire a child to be seen at the time of a scheduled visit for another child. | $50 |
| Appointment cancellations | Any Sick Visit including same day appointment. 24 hour notice required for Well Visit. | Fail to show/late cancellation $35 Fail to show/late cancellation $60 |
| Forms | Make request in writing with stamped, self-addressed envelope or arrange to pick up forms at the office. 10-14 working days are required to complete forms. Forms cannot be faxed. Forms may be picked up from 8:15am-5:00pm. | $15 for the 1st form $10 for any additional $15 additional for each expedited form. |
| School Forms (Note: Allow 4-6 weeks to schedule physical exams for school) | Varies | |
| Co-pays, deductibles and account balances | Due at the time of the visit | Varies |
| Medical Records | Medical Release Downloadable Form below | $30.00 per child for current patients. $55.00 per child for chart retrieval from off site medical records storage facility. If you have not been seen by our practice for 3 years or more, your records will be transfered to this storage facility. If records are then needed, the patient will be responsible for paying the retreival fee. |
| Referrals | All referrals require 48 hours notice | No Charge |
Payment is required at the time of service. For your convenience, we accept cash, check, Visa, and MasterCard.
Insurance
Your insurance coverage is a contract between you and your insurance company. It is your responsibility to know the limits and benefits. CMG will assist your insurance company in processing your claim when necessary; however, you are ultimately responsible for the payment of your account.
We will file insurance claims only for the plans in which we participate at any given time. These plans currently include:
| AETNA:PPO; POS starting with ‘W’ or all numbers; No HMO | BCBS PPO & BCBS Federal |
| MDIPA | CareFirst Blue Choice |
| OneNet PPO | MAMSI * |
| Optimum Choice | United Health Care * |
| Champus | CIGNA |
| Tricare | GEHA |
Due to variations in policies, it is your responsibility to check with us and your insurance plan to be sure they consider us as participating providers.
As a patient of CMG, we will bill your insurance company and be reimbursed directly. You are responsible for the co-payment and deductibles at the time of service. There will be a $5 processing fee for any additional forms that must be completed by the billing office. We do not file secondary insurances.
If your insurance denies payment for services rendered for any reason, we will bill you directly and payment is expected within 30 days. Your insurance company may reimburse only part of your claim if:
- You have not met your deductible.
- Our fees are above their usual customary rate.
- Your policy does not cover the service rendered.
- Patient is not covered at the time of service.
There is a $25 charge for all returned checks.
You should communicate directly with your insurance company to settle any disputes over claims and reimbursements. We appreciate your cooperation. Inquiries or concerns regarding your bills should be directed to CMG’s billing department at 240-482-1544 or 240-482-1545.
Downloadable Forms
For your convenience attached are forms you can prepare in advance and bring with you to your visit. If you have any questions or problems downloading forms, please do not hesitate to call us at 301-907-3960.
Medical Release Form
School Forms
Montgomery County Public School Health Form Part 1
Montgomery County Public School Health Form Part 2
Authorization to Administer Prescribed Medication
District of Columbia Universal Health Certificate