Bunn Patient Assistance Program

This program is designed especially for the uninsured to help them get quality affordable health care. This program is only for those who do not have medical insurance. This will cover office visits at this office. No insurance will be filed.

Following is the fee schedule.

1. Joining fee (one time) - $60.00 per patient (non refundable)

2. Monthly fee - $45.00 per patient (non refundable)

3. Co-pay -  1-15 visits - $10.00 per visit.

                     16-25 visits - $15.00 per visit

                      > 25 visits - $ 20 per visit

4.  Two post dated checks, cash or pre paid credit card for 2 $45 monthly payments.

What it includes:

1. Unlimited office visits.( you have to pay the co-pay only). Cultures and send outs are not included.

2. One yearly physical.

3. One yearly blood panel.

4. One yearly pap for ladies.

What is not included :

1. Any other office procedure, like EKG,Urine Dip, nebulizer treatment or  Urine Analysis, Finger stick, or rapid strep test.

2. Lab work beyond one yearly panel.

3. Minor surgeries, joint injections or antibiotic injections.

4. Hospital Charges, Any hospital visit will be charged separately.

5. No medicine is included. You have to buy it yourself.

6. This program covers your visit to this office only. We are not responsible for the payment of your bill to any other doctor, hospital , pharmacy or agency.

Your responsibility:

1.Pay monthly dues on time to avoid cancellation of BPAP membership.

        Pay by the 7th of the month - $45.00

        Pay between the 8th - 10th of the month - $ 47.00

        Pay between the 11th - 15th of the month - $ 50.00

BPAP membership agreement will be cancelled if no payment is received by the 15th of the month. No refund will be given.

2. Co-pay is due at each visit. You have to pay the co-pay before being seen.

Cancellation of  BPAP membership agreement :

The BPAP membership agreement will be cancelled immediately for any of the  following reasons :

1. Non payment of monthly or other dues.

2. If your check is returned for any reason and you do not take care of it in timely manner. ( A separate  returned check fee is added.)

3. If a legal dispute or litigation arises.

4. If our prescribed medicines are misused, e.g. the controlled drugs.

5. Any other reason which need severing of doctor-patient relationship

The BPAP membership agreement will cease immediately and no refund will be given. You will have one month to find a new doctor. During this period you can see us on payment of our regular office visit charges.

The fee mentioned is guaranteed for one year. Bunn Medical Center reserves the right to revise the fee structure after this period. If for some reason BMC decides to discontinue this program, all existing members will get at least 12 months of benefit from the date of registration.