Refund Policy | Spine & Orthopedic Center

How To Request a Refund?

In the event that you would like to request a refund for outstanding credit balances on your account, please follow the following process to ensure proper handling and timely refund processing:

To begin the process, please use the Refund Request Form below or call our billing department at (888) 409-8006, from Tuesday to Friday from 9:00 am to 5:00 pm.
Please let the billing representative know your call is regarding a refund and which insurance carrier you have.
Upon acknowledgement by our billing personnel, the account in question will be reviewed in detail prior to processing the refund.
After we process the refund, it can take your bank up to 30 days to release the funds to you.
Please consider that if it is determined that there are other outstanding balances on the account apart from the charges in question, the requested refund will be reduced by such amounts.

How long does it take to receive a refund?

Please allow up to 30 business days from the time the refund is requested to receive the refund.

Refund Request Form

Date of Request*
MM slash DD slash YYYY
Patient Name*
First Last
Date of Birth*
MM slash DD slash YYYY
Phone Number*
Email Adress*
Please check each line below to acknowledge receipt of Refund Policy*
- Patient acknowledges that refunds may take up to 30 business days, once your account has a zero balance or reflects a credited balance.
- Patient acknowledges that account will be reviewed for prior unpaid balances before approval can be determined.
- Patient acknowledges that all insurance claims must be processed before a reimbursement can be issued.
I would like to pick up my refund check at:
I would like my refund check mailed to: **
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
** Please note when selecting the option to have a check mailed: the fee to have refund check mailed will be $10. This includes certified mail and return receipt which will be deducted from the refunded amount. If the check is lost in transition to the address provided, a stop check fee of $50 and a reprocessing fee of $25 will be deducted from the original refund amount.
Acknowledgment*
- By checking this box I acknowledge that I read and understood the Refund Policy.