Thank you for choosing us for your chiropractic care. We are committed to providing you with the best care possible. It is the policy of this clinic that payment if due at the time of service unless other financial arrangements are made in advance.

Group Health Insurance:

We are not in network with any insurance carriers other than Original Medicare. You will be considered a CASH PATIENT.

Medicare Part B (Original Medicare):

We are a participating provider with original Medicare and file claims for Medicare covered procedures. If you have a secondary policy, it may or may not pay for the services not covered by Medicare. Many secondary policies automatically cross over from Medicare. Please note, if yours does not, we do not bill the secondary insurances. You will be responsible for this copayment.

Medicare Replacement Plans (Medicare Advantage / Part C):

If you are enrolled in a Medicare Advantage plan (“MA” plan or Part C), where another insurance company administers your Medicare benefits, this means Medicare no longer pays for your healthcare. We need to know this so that we do not erroneously bill Medicare on your behalf. You will be considered a CASH PATIENT.

Cash Patient:

Payment in full is expected at the time of service. See “Time-of-Service Discount.” We will gladly provide you with the necessary information for you to complete and file your claim directly with your insurance company to see if you have out-of-network benefits. You can use your flex dollars or Health Savings Accounts here.

Automobile Accident / Personal Injury (PI):

There are three options available to the Auto Accident patient:

• Pay cash for your care and we will submit reports whenever necessary.
• We will submit claims to your auto insurance’s Personal Injury Protection (PIP) or Med Pay. You have PIP coverage, unless you rejected it. Report the accident to your insurance agent and request a claim number and the appropriate billing information right away. Be sure to bring the following information: Police report and Auto insurance information: Insurance Company, Adjuster name, Claim Number, Phone number, Fax number, and address. If an attorney is representing you, let us know right away.
• We will accept a Letter of Protection from an attorney.

Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to 6 months after your care is completed. Once the claim is settled or if you suspend or terminate care, any fees for services are due immediately.

Financial Hardship:

Our main concern is your health and well-being. If you have financial difficulty, special payment arrangements may be made.

Missed / Cancelled Appointments:

The timeliness of treatment is important in getting the best results. We request a 24-hour notice of cancellation. This provides time to work other patients into the schedule. Please help us serve you better by keeping your scheduled appointments.

Dismissal of Care:

Your treatment program has been recommended for a required level of correction. Keeping your appointments is vital for your success. Should you repeatedly miss your scheduled appointments or interrupt your care for an extended period of time, we may find it necessary to dismiss you and remove ourselves as your physician.

Statements:

Statements are mailed for any remaining balances due. Upon receipt, we ask that payment be made in full within 30 days, unless arrangements have been made in advance. If you have a large balance, we will work with you to establish a payment plan.

Time-of-Service Discount:

We are pleased to offer everyone a Time-of-Service Discount. This is a discount on certain procedures and is available to everyone making payment at time of service.

Forms of Payment Accepted:

For your convenience, we accept cash, checks*, debit card, MasterCard, Visa, and Discover.

*Returned checks are subject to a $30.00 charge in addition to the original check amount. Repayment will be required in cash, money order, or credit card form ONLY. Payments made by credit card over the phone are subject to a 4% convenience fee.

Medical Records Requests:

We will gladly provide you with a copy of your medical records upon written request. These are subject to fees. Doctor to Doctor records are complimentary.

Completion of Forms: 

There is a $25 charge for completion of disability, FMLA, and other special request forms.

Past Due Accounts:

Please understand that, regardless of filing, settlements, claim disputes, you have the ultimate financial responsibility.

Patients who have not made an effort to make payment arrangements or have not expressed an interest in meeting their financial obligations to us may be picked up by a collection agency. Accounts 90 days past due will be put into the collections process. Patients who allow their account to be picked up by a collection agency are expected to satisfy their financial obligation. These patients are expected to pay for any future services in advance.

Our practice is committed to providing the best treatment to our patients. Our prices are representative of the usual and customary charges for our area.