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Billing Policy

  • I understand and agree that I am responsible for the balance of my account for any professional services rendered, regardless of my status or insurance coverage.
  • I understand that if required, I am responsible for obtaining a referral from my primary care physician, even if I was first seen in the hospital/emergency room.
  • I understand and agree that if I do not have health insurance or a current referral, a $100.00 deposit is required at the time of my visit and a payment plan will be set up to pay the remainder of the cost.
  • I understand that my co-payment is to be paid at the time of my visit.
  • I understand that $50.00 will be charged for each appointment missed without providing prior notice to Dr. Marilyn Boyuka, and there will be a $36.00 charge for bounced/insufficient funds checks written.
  • I authorize the use of this form on all insurance submissions. I authorize Southern Tier Podiatry to act as my agent in helping me obtain payment from my insurance company and I authorize payment of medical benefits directly to Southern Tier Podiatry. I authorize Southern Tier Podiatry to release medical information required to process my claim.
  • Insurance Deductible Policy: If your deductible has not been met at the time of your appointment, we will collect 60% of the charges for that day of service, at time of your visit. Your insurance company will be billed and if you owe an additional amount; you will receive a balance bill.

To view the full Office Policy please click here.


Southern Tier Podiatry
4104 Old Vestal Rd, Suite 104
Vestal, NY 13850
Phone: 607-284-5465
Fax: 607-821-0255

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