TERMS AND CONDITIONS
REQUISITION All requisitions must be submitted legibly to Gramic Research Laboratory, LLC and must be completed in full. Patient’s name (first and last name), date of birth, address, telephone number, gender, social security number (when applicable), Insurance Information including address + telephone number (primary and secondary-attach copy), Patient’s insurance policy number, Patient’s insurance group number, name of ordering physician, Physician’s signature, Physician’s UPIN#, Date of Draw, and Test with associated ICD-9 code is required.
INSURANCE Gramic Research Laboratory, LLC does direct billing to Insurance Companies. However, in those instances when payment is denied due to non-participation (HMO’s and any others which apply), Gramic Research Laboratory, LLC will consider the account responsible and will bill accordingly. Gramic Research Laboratory, LLC does not accept any HMO’s or any “in-network” insurance plans which do not allow for out-of-network services to be provided. It is the responsibility of the Client/Account to verify all insurance plans prior to submitting requisitions to Gramic Research Laboratory, LLC.
PAYMENT All payments to Gramic Research Laboratory, LLC must be made by check or money order in U.S. Dollars and must be delivered or mailed to the address indicated on your billing statement.
INVOICE/STATEMENT All services will be invoiced on a monthly basis. If you have a balance owing on your Account (“Account” or “Account Balance”) or have any Account Activity, a statement/invoice will be sent monthly. All charges for tests, late fees, etc will be indicated on the Account Statement/Invoice as well as the Account Total Due for services rendered.
PROMISE TO PAY By charging laboratory tests to your Account, you are obligated to pay ALL charges associated with such tests. Payment is due upon receipt of each month’s Billing Statement and is considered Past Due if not received within thirty (30) days from the date of the Billing Statement.
LATE PAYMENT FEE Gramic Research Laboratory, LLC will charge a late payment fee of 1.5% of your Account Balance.
RETURNED ITEMS Gramic Research Laboratory, LLC will charge a returned check fee of $25.00.
BILLING STATEMENTS SUBJECT TO DISPUTE Any or All disputes concerning charges on the Billing Statement must be made in writing by certified or registered mail within thirty (30) days of the Billing Statement stating the item in dispute. The letter of dispute must provide your Account name, telephone number, a copy of the Billing Statement, a description of the error or dispute. Failure to follow the procedures as outlined herein will hold you responsible for the payment of ALL charges as outlined on the Billing Statement.
REVIEW OF DISPUTES Gramic Research Laboratory, LLC will respond in writing within 30 days upon receipt of the dispute unless the dispute has been resolved with the Account/Client prior to the 30 day period. ALL disputes will be thoroughly investigated and no collection activity or consumer reporting will take place during this period. ALL other charges on the Billing Statement that are not being disputed must be paid in accordance to the terms as listed above.
DISPUTE OUTCOME Upon completion of the dispute review process Gramic Research Laboratory, LLC will notify Account/Client of its findings. If the dispute is found in favor of the Account/Client, the Account/Client will NOT be responsible for the disputed charge(s). If Gramic Research Laboratory, LLC finds that no error or correction is in order, then you will be responsible for the charges. In the event that you disagree with the decision, Gramic Research Laboratory, LLC must be notified in writing via certified or registered letter within ten (10) days following the written notification of the final outcome. Failure to follow this procedure as outlined will result in Account/Client responsibility for ALL charges.
COLLECTION COSTS Outstanding Account/Client balances will be referred for collection or sent to a collection agency. Included, subject to any limits under applicable law, attorney’s fees, legal expenses, appeals, and/or any other expenses related to such.
TERMINATION OF ACCOUNT Gramic Research Laboratory, LLC reserves the right to terminate services to your account without notice if payments are not made in accordance with this agreement.
ACKNOWLEDGEMENT AND AMENDMENTS By signing this Agreement, Account/Client Acknowledges to have read the above and Agrees to the TERMS and CONDITIONS as written herein. Account/Client further agrees to comply with the TERMS and CONDITIONS as outlined herein.
E-mail: Info@Gramiclab.com