Payment Policy
Patients are typically responsible for charges including co-pays, deductibles, co-insurance, or services that are not covered by your existing health insurance plan. Services may not be covered if there is a pre-existing condition clause, or if your plan does not cover preventive services. Student plans and basic plans often have limitations of coverage. Travel vaccines are also not covered by insurance. We kindly ask that all patients/clients provide us with a valid credit card upon establishing care to be used only if any charges are not covered by your insurance plan. Your card will only be charged after all payments have been received from your insurance company, and it is determined that the patient is responsible for the balance. If your responsibility is $40 or higher we will email you prior to charging your card, to ensure you are aware of your balance. We have initiated this policy to reduce the waste associated with printing and sending invoices.
We will charge your card based on the statement called an explanation of benefit or EOB that we receive from your plan. If your card is charged we kindly ask you to contact your insurance plan for an explanation as our charges are based solely on the information they have provided us. You should receive an explanation of benefits notice from your insurance plan in the mail shortly after your visit.
Cancellation Policy
We ask that you please give us one business dayâ??s notice before cancelling your appointment. If you do not call us to cancel your appointment or do not show for your appointment, you will be charged as follows: Internal Medicine / Dermacenter: $25, Nutrition: $125 initial / $65 follow up,
Fitness / Yoga: $65, Psychology: $150. Please be assured that all card numbers are kept in a secure password protected system. Before charging your card we will double check the claim to make sure it is correct and that our office has not made a mistake. By signing below, you acknowledge that you understand your financial responsibilities as a patient. You authorize payment in full via your credit card by your signature below for any and all payments due today and in the future dates of services, for consultation, evaluation and procedures performed. Please keep your credit card information updated.
By signing below you acknowledge that you have had the opportunity to ask questions regarding this payment and cancellation policy and have had the opportunity to decline participation with this office.
Collections Policy
In the event that there is an outstanding balance on your account the following collection procedure will take place.
1. Your credit card on file will be charged for any balances under $40 as outlined in our payment policy.
2. If a balance of more than $40 is owed you will be notified via email of the amount due with a request to authorize us to charge the credit card on file or contact us with another form of payment. This is considered your 1st notice.
3. After 30 days of no payment/reply you will receive your 2nd notice via email.
4. After 30 days from your 2nd notice of no payment/reply you will receive your 3rd and final notice via email, a statement in the mail and phone call from the office. If payment is not received your account will be forwarded to Chase Receivables for collection.
