Financial Responsibility

Financial Policies

We would like to thank you for choosing the Lapeer County Surgery Center for your healthcare needs. To keep you informed of our current financial policies we ask that you read and sign our financial acknowledgement prior to any treatment. This patient financial policy form will be presented to you for signature during the registration process on the day of your procedure.

Financial Policy:

LCSC requests payment in full for all applicable deductibles, coinsurance and co-payments at the time services are rendered unless other arrangements have been made in advance with LCSC. LCSC participates with many insurance companies, and due to the ever changing nature of these contracts, it is impossible for us to know the deductible, co-payment and coinsurance details of every contract. It is your responsibility as the patient to know your specific contract details. Once services provided have been processed by your health insurance carrier and the balance deemed your responsibility, you will be notified by a statement of any outstanding balances. You will have 90 days from the time you receive your first statement to pay your balance in full. If your account remains delinquent at the end of 90 days you will automatically be turned over to our collection agency and this will reflect on your credit report.

No Insurance:

Payment in full will be due prior to date of service.


Please bring your insurance card with you at the time of your appointment. For insurance plans that we contract with, your carrier requires that all co-pays be paid prior to any services being rendered. The co-pay requirement cannot be waived by our facility, as it is a requirement placed on you by your insurance carrier. You are responsible for any co-insurance, deductibles or non-covered services as required by your insurance. You will receive a statement from our facility indicating what your insurance has paid. Any remaining balance is due upon receipt of that statement.


For POS and HMO insurance plans that we participate in, your insurance carrier requires that you obtain a referral from your Primary Care Physician (PCP) before receiving services. Please bring that referral with you. Any services received without a referral or proper authorization will be your responsibility.

 Accepted Payment Methods:

Cash, Check, Money Order, Credit/Debit Cards.

 Return Checks:

A $30.00 charge will be added to your account for any checks returned by your bank for any reason in addition to any fees that your financial institution may charge you.

Previous Balance:

In the event of a balance from a previous visit, Lapeer County Surgery Center reserves the right to withhold scheduling any services until the balance is paid in full.

Please keep in mind that the above financial policies pertain only to Lapeer County Surgery Center. You may also receive separate charges from your surgeon, anesthesiology, and/or laboratory charges.

Click HERE to download our Financial Responsibility form.