Insurance Policy

Payment Policy

Providing Inpatient and Outpatient Pediatric, Adult, Geriatric, Obstetrics, and Endoscopic care for you and your family

Midlands Family Medicine

North Platte Clinic

611 West Francis St Suite 100

North Platte, NE 69101

Phone: 308.534.2532

Fax: 308.534.6615

Email us here

New Office Policies effective January 1 2014

Midlands Family Medicine does everything possible to minimize the cost of medical care. You can help by following the payment policy we have set.  For your convenience, we accept credit cards including Visa, Mastercard, American Express, Discover and debit cards both online through our website and in the office.


Payment is expected prior to being seen


Payments of all copays, deductibles, and /or coinsurance are due at the time of service. If you have no insurance, $110 is the minimum required to be seen.  For those with high deductible insurance plans, we will require an upfront charge of $100 per visit which will be applied to your office visit and your deductible.  These amounts are initial payments and do not necessarily reflect the entire amount due from your office visit; the outstanding balance from the office visit can be paid at the time of the visit or can be billed to you.  Upon reaching your full deductible or maximum out of pocket expenses for the year, please provide us documentation from your insurance company that these requirements have been fulfilled and subsequent visits for the calendar year will no longer require the payment amounts noted above.  If you have a policy with a copay, your copay amount is the only amount due at the time of service and the $100 per visit amount does not apply to you.


We will continue to file all your insurance. If payment is not received from the insurance carrier or other responsible third party in 60 days, we have the right to bill you directly for all services. Please notify us immediately of any changes in your insurance.


If you are here as a result of a motor vehicle accident we require you to take all billing to your Auto Insurance. We will not hold claims more than 60 days while settlement is determined. If we do not receive payment in that time from insurance, you will be personally responsible for all charges and payments is required immediately.



We do accept Medicare assignment and will file all supplement insurances. As a Medicare patient you are responsible for your deductible, which we will bill you for after we have heard back from both insurances. Medicaid/ State of Nebraska/Arbor/Coventrycares, anyone of these will be verified through the websites. If they show no coverage, $110 payment will be required for the visit or you will need to reschedule until you have fixed your coverage.



Patients with an outstanding balance of 60days overdue must make arrangements for payments prior to scheduling appointments. We realize that people have financial difficulty. Please communicate with our billing and collection staff so that they may assist to create a financial plan for payments and therefore preventing your accounts from being turned over for professional collection.



Overpayment s will be refunded upon request to the responsible party within 30 days of our office confirmation.

Midlands Family Medicine is a Preferred Provider Organization for Medicare, UPREHS (Union Pacific Railroad Employees Health Systems), Blue Cross/Blue Shield, Midlands Choice, United Healthcare, and Mutually Preferred insurance companies.

Whatever insurance you may have, it is your responsibility to provide us with all group, policy, and individual identification numbers along with any required signatures so that we can bill your insurance correctly. Always bring your insurance card with you to ensure that you receive the benefits you are entitled to under your health plan. Please note that we will not bill your second or supplemental insurance unless we are a Preferred Provider Organization for that insurance company. If you will be filing your second insurance yourself, be sure to ask for a copy of the fee and diagnosis sheet for that day's visit. You will need this sheet to file your claim with your second insurance company.

In the event of an injury or illness that prevents you from working we will complete your disability forms for you. You must complete and sign your section of the form before dropping it off at the clinic. Your signature is required before we can release any of your confidential patient information regarding your disability. You will need to provide us with information regarding any dates of hospitalization, physical therapy performed, or visits to other doctor's offices.
If we do not have all of this information it will prevent us from being able to file your form in a timely manner. Please allow us a few days to complete the forms. Upon completion, you may pick up your disability forms at the reception desk, or, if you prefer, we can mail them to your insurance company when you provide us with a stamped envelope. We can not fax the forms or call your insurance company.

We will file Worker's Compensation Claims if you have an on-the-job injury. Please complete a Worker's Compensation Claim form when you arrive at the clinic so we have all the information necessary to properly file the associated charges. You must provide us with the correct company name, address, and a contact telephone number in order for us to be able to file claims for you. If you do not provide this information, we will have to bill your account for the charges related to the accident. If your Workman's Compensation claim is denied by your employer's insurance company you will be responsible for any charges that have been incurred.

We will not wait indefinitely for your insurance company to pay on your insurance claims. If a claim becomes 150 days old and you insurer still has not paid on it, you will become responsible for the charge incurred. At this point you will want to call your insurer and find out why they are taking so long to pay on the claim. Please refer to our Credit Policy for more information regarding this issue.