Harry Cotler, D.P.M.

Affiliated Foot & Ankle Care
 35670 Kenai Spur Highway, Suite 102
 Soldotna, AK  99669
 (907) 260-3668 (Foot)
 footdoc@alaska.net

Your insurance card and verification of your coverage is required prior to seeing Dr. Cotler. At the time of your treatment, you will be responsible for any co-pay, deductible, coinsurance, or fees for any non-covered services. You may make payment using cash, personal check, VISA, MasterCard. Please read this entire form completely.

Broken Appointments: Patients will be charged $10.00 if they do not call the office to cancel an appointment that they are unable to keep. Please try to give us a 24-hour notice so that we may give your appointment to another patient. It is your responsibility to keep your appointment at your scheduled time.

Medicare Patients: This office accepts Medicare assignment and files all secondary insurance for you. However, you are fully responsible for your initial yearly deductible, which will be collected at the time of your visit and is subject to Medicare allowable charges for the services you receive. Once your deductible has been met, you are responsible for your 20% coinsurance at the time of your visit unless you have a secondary insurance that will cover these charges. Remember that Medicare pays 80% of their allowable charges, leaving 20% to be paid by you, or covered by your coinsurance! Federal law requires that physicians who accept Medicare assignment collect these amounts! Please be aware that certain podiatric care is not considered reimbursable by Medicare (non-covered), and that you will need to pay for these services at the time of your visit. You will always be informed that your charges are non-covered by Medicare before the service is rendered.

Medicaid Patients: This office accepts Medicaid, however; the patient must be younger then 21 or have another insurance that is primary to Medicaid.  We are hoping that the federal guidelines will change and that there will be no discrimination against age.  Unfortunately if you are 21 and older and do not have other insurance you will be responsible for full payment.

Veterans: We would be happy to see you in our office, but would require authorization from the VA prior to treatment.

Workers Compensation:  Again, we welcome you to our office and hope for a quick recovery, but prior to treatment would require authorization.

Blue Cross of WA/AK, Aetna and RBMS:  We are contracted with them and accept their fee schedule, please keep in mind that deductibles and co-pay still apply. 

Pre-surgical Payment: For all surgical cases, including office procedures such as ingrown toenail removal, your insurance company will be contacted for pre-certification and verification of coverage and specific benefits. Any deductible that has not been met for the year, plus your estimated coinsurance, if applicable, will be due prior to the surgery. Once our office has received payment from your insurance company, you will be billed for any amount still owed. If there is a payment credit, a check will be issued to you within 30 days.

Payment Terminology: The following payment terms are defined below for assistance in understanding insurance benefits and payments, as well as to explain our need to collect payment in addition to filing your charges with your insurance:

Co-pay: the $10, $15, $20, etc. amount that usually appears on your insurance card. There may be one amount for primary care, and another, higher amount for a specialist.
 

Deductible: the $100, $250, $500, etc. amount required annual payment from you to your physician before your insurance begins to pay for your charges. This amount is in addition to your copay.
 

Coinsurance: the percentage amount that your insurance requires you to pay to your physician after you have paid your deductible. Your plan may pay 80% or 90%of allowed charges, requiring you to pay the remaining 20% or 10% due. When you have met your "out-of-pocket" limit specified by your plan, your insurance will then pay 100% of allowed charges.
 

If you have any difficulty understanding these policies or the explanation of how your insurance works to pay for your medical care charges, please ask to speak with our Office Manager.