Wintergreen Medical Center
324-A Beacon Drive
Winterville, NC 28590
Calvin Ellis, PA-C
Carol Gates DNP, FNP-BC
1. We require payment in full for services at the time of service. This includes copay PLUS any
patient balance due (from previous visits). We accept cash, local checks, Visa and MasterCard.
We also accept payment by credit card by phone.
2. If we receive a bad check, we charge a $20 bad check fee, to be paid with cash or credit card
only. In the future, we will not accept any further checks from any individual who has written a bad
3. We charge $30 for any missed appointments where we have received no advance notice of the
intent to miss the appointment. Of course we may waive this fee for unusual circumstances at our
discretion. All patients have signed an agreement to this effect when they become patients here.
4. We give appointments at the time of checkout and we expect patients to record and remember
their appointments. We are not responsible for "reminding" patients of their appointed times,
although we do attempt to contact patients prior to their appointments as time permits, as a courtesy
to patients. This is done through an automated phone system. If you would like to be called at a
different number than your home number, please let us know. Please do not depend on a "reminder"
phone call to remind you of your appointments. We believe that our patients are responsible enough
to record their appointments and keep them.
5. We promise to make an effort to accurately code and bill for services rendered. From time to time
your insurance company may require you to update your insurance information before they will remit
payment. We will inform you if they are requiring further information from you before we bill you.
6. If you ever have any questions regarding your bill with us, please call our office and ask for Sue
Davenport, our Billing Manager. She may ask that you come in for a face to face visit if necessary to
explain your account.
6. Once a patient's account has become past due for more than 90 days, that patient will be
contacted once by phone and will have one week to come in and either (a) pay their balance in full, or
(b) sign a contractual agreement to pay their entire balance over the next 3 months, including the first
payment of 25% of the balance at that time.
7. If a patient does not pay the balance in full or 25% of the balance within one week as stated in (6)
above, that patient will be contacted and will be discharged from our practice. They will be given 30
days to find another provider, and during that 30 day period, will be seen at our office only for urgent
or emergent issues. We will refill their medications during that 30 day period, if necessary.
8. There are no exceptions to the above policy, unless agreed upon by the patient Mr. Ellis
minimal waiting time during appointments, and minimal waiting time for an appointment to
However, we incur extensive costs running this practice, and we depend on prompt payment
from patients for services rendered. We ask that everyone please continue to remit payment
as soon as requested. We sincerely thank you for your prompt attention to your account.