Patient Information

Financial Policy Agreement

Our goal is to make your care clear and affordable. Below is a plain-language summary of our billing, insurance, and appointment policies. If you have questions, please ask our front desk before your visit.

Insurance Responsibility and Verification

You are responsible for knowing your insurance benefits, including whether our providers are in-network for your plan, and for any copays, coinsurance, or non-covered services. To confirm network status, contact your insurance carrier and reference these NPI numbers:
Dr. Sam Russo: 1891828398
Katlin Mostue-Nesbit, APRN: 1427665017

Current in-network plans (subject to change; please verify with your insurer):

• Blue Cross — Dr. Russo: BCBS of Vermont, Federal BCBS, CBA Blue; Katlin Mostue-Nesbit NP: all BCBS plans
• Cigna — some plans; please check with your plan
• MVP
• Vermont Medicaid
• Aetna — some plans; please check with your plan
• Medicare — Katlin Mostue-Nesbit NP only

Payment Policy

At time of service: Payment is due at the time of visit for copays, non-covered services, out-of-network services, and nonbillable laboratory tests. We accept cash, check, Visa, MasterCard, Discover, and American Express.

After insurance processes a claim: If your insurer determines a balance is your responsibility, you will be billed and payment is due upon receipt of the statement. Balances over 90 days incur a finance charge calculated at an annual rate of 10%, applied monthly to the outstanding balance.

Services Outside an Office Visit

Services provided outside a scheduled office visit may be billed and submitted to your insurance when appropriate. Examples include:

• Portal or telephone evaluations that require clinical decision-making
• Prescription refill requests when an office visit is due
• Resubmitting expired lab or imaging orders
• Completing specialist referrals requested outside an office visit
• Completing letters, forms, or documentation outside an office visit

Common CPT codes we may use for these services: 98016, 99421, 99422, 99423.

Preventive Visits versus Office Visits

Preventive visit: Focuses on overall health, screening, and prevention (age-appropriate screenings and immunization counseling). Preventive visits do not include evaluation and management of new or changing symptoms and typically take 30 minutes.

Office visit (evaluation and management): Used to evaluate or treat a specific concern or new symptom (for example: joint pain, new or worsening mood symptoms, a changing skin lesion, or elevated blood pressure). If a preventive visit includes a new problem that requires additional evaluation or treatment, that portion of the visit may be billed as an office visit.

Missed Appointments and Cancellations

Please provide at least 24 hours’ notice to cancel or reschedule.

• First missed appointment or late cancellation: no penalty.
• Second missed appointment or late cancellation within 12 months: you will be charged for the appointment (Medicaid patients exempt by state law). You will also receive a letter notifying you that, for six months, you will be limited to same-day scheduling. If you keep appointments reliably after six months, normal scheduling may resume. Continued missed appointments or late cancellations may result in dismissal from the practice.