Capitol Medical Group

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.

CategoryProcessAdditional Fees
Scheduled AppointmentsAll 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-insTime 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 cancellationsAny 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
FormsMake 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. A physical examination by a practitioner must be completed within twelve months prior to filling out school or camp forms.$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 balancesDue at the time of the visitVaries
Medical RecordsMedical 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.

ReferralsAll referrals require 48 hours noticeNo Charge

Payment is required at the time of service. For your convenience, we accept cash, check, Visa, and MasterCard.


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 HMOBCBS PPO & BCBS Federal
MDIPACareFirst Blue Choice
Optimum Choice United Health Care *

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:

  1. You have not met your deductible.
  2. Our fees are above their usual customary rate.
  3. Your policy does not cover the service rendered.
  4. 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

Contact CMG

Capitol Medical Group
8401 Connecticut Ave, Suite 201
Chevy Chase, MD 20815

Reception/Appointments: 301-907-3960
Main Fax: 301-652-4933
Billing: 240-482-1544
Answering Service: 240-638-9730
CMG Adult Medicine: 301-304-8800

Copyright © 2023 Capitol Medical Group. All rights reserved.

301-907-3960Monday - Friday 8:00am-4:30pm \ Saturday - 8:30am-12pm8401 Connecticut Ave, Suite 201, Chevy Chase, MD 20815CMG Adult Medicine