Financial Policy - Insurance
Insurance
An insurance agreement is a contract between 3 parties: 1). You 2). Your health insurance company 3). Your doctor’s office. All 3 parties must live up to the terms and conditions as stipulated by this agreement. The patient agrees to pay a premium to the health insurance company. The health insurance company assumes the health risk(s) for the patient(s) and agrees to pay negotiated fees to a medical or allied health provider for services rendered to the patient. The medical or allied health provider agrees to provide medical services to the insured patient at a negotiated rate via the provisions of the health care contract. Agreements and contracts can vary between insurers and change periodically over time with or without due notice. We will outline below typical policies used in the health insurance agreements. For the most accurate and up to date information, we recommend that you contact your insurer directly.
1). Deductibles: Deductibles are the amount required by the insurer to extend benefits to a patient. Deductibles are the sole responsibility of the patient. As per contractual agreement, we are required to collect the deductible (if applicable) for medical and allied health services. We cannot waive deductibles for any reason.
2). Co-Payments: Co-payments are the amount required at the time of service to provide medical or allied health services to a patient. Co-payments must be collected. We cannot waive co-payments for any reason.
3). Co-Insurance: Co-insurance is the amount the patient is required to pay for health care services. For example, if coverage is 80%/20%, the insurer would pay 80% of the contracted rate with the patient paying 20% of the contracted rate. We cannot waive co-insurance for any reason.
4). Non Covered Services: Periodically, treatment plans may consist of non-covered services either by patient request or by medical necessity. Examples of non-covered services can include internal health services (blood draws, saliva testing, urinalysis, stool testing, specialty lab testing), acupuncture, orthotics or other services. Your plan specifically dictates coverage. We will verify benefits and notify patients of covered and non-covered services involved in their treatment plan; however, it is ultimately up to the patient to be aware of coverage limits, covered services, non-covered services and other stipulations within their contract. Patients can refuse a covered or non-covered service. Refusal of medical or allied health services may impact the care received at our office and jeopardize the patient’s outcome.
5). Submission of Claims: We will submit 2 total claims for the patient: 1). An initial claim 2). A revised claim should the initial claim be denied. Patients are ultimately responsible for their balances should claims be denied for any reason. This policy would take into consideration applicable insurance contractual agreements.
6). Verification of Benefits: We will pre-verify benefits prior to or during care at no cost to the patient. A verbal and/or written quote of benefits will be given to the patient. It should be stated that a quote of benefits does not guarantee payment. Please contact your insurance carrier directly if further questions arise.
7). Wellness Services and Maintenance: Some insurers not allow us to submit a claim for wellness or maintenance services. Wellness or maintenance services are non-covered services. Maintenance services are typically defined as a “treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life; or therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.” - Center for Medicaid and Medicare Services
8). Secondary Insurance: Periodically, patients will have a secondary insurance. Please notify our office directly which policy is the primary and which is the secondary. Also, please be able to provide the pertinent information needed for both policy holders (name, date of birth, address, phone number, etc.)
______Signature Date
*** I acknowledge with my signature that I have read and understand the terms and conditions of this document. I understand that I have financial and personal responsibility to participate in my care. I have been made aware of this verbally via a quote of benefits and in writing via this document***