Payment
Payment:
We are an out of network provider with all insurances and are opted out of Medicare and Medicaid. We do not take any Workman’s Compensation or motor vehicle accident claims. Payment is due at the time of service. We accept cash, personal checks, and credit/debit cards including HSA and FSA cards.
Upon request, we will provide patients with a super bill that can be submitted to their private insurance provider for consideration of reimbursement. Please check with your insurance provider to see if/how out of network providers are covered. See an example questionnaire below to help collect information on how/if you could be reimbursed from your private medical insurance company. It is your responsibility to fully understand your insurance policy.
Expected cost of visits:
New Patient OMT visit (up to 75 minutes): $420
Follow-up OMT visits (up to 50 minutes): $360
Missed appointment/late cancelation policy:
Please let the clinic know if you are unable to make your appointment as soon as possible. Any appointments that are cancelled within 2 business days of the patient’s scheduled appointment time, as well as missed appointments, will be charged the full appointment fee.
PPO Out-of-Network Questionnaire Form:
This form will help you determine what your insurance benefits are and consequently, what your out-of-pocket costs will be for a typical visit at our office. You should know that some policies get very complex especially in regards to preventive care. Remember that we are an “OUT-OF-NETWORK” provider. Have your insurance card or policy handy when you call their customer service number and ask the following:
"I would like a quote of benefits for a sick medical office visit with an OUT-OF-NETWORK family practice doctor."
Today's Date/Time:_____________________
I spoke with:___________________________
What is my effective date of coverage? ____________________
At what percentage are my claims paid? ___________
Do I have a deductible? __________
If yes, how much is my deductible? __________
How much of my deductible has been met so far? __________
When does my deductible renew, calendar or policy year? __________
What is my maximum out-of-pocket? __________
Has anything been applied to my out-of-pocket? __________
How much is covered on the procedure code 98925-98929? ______________
Is there a limit to the number of 98925-98929 procedures covered in a certain time period? ____________
What is the mailing address or fax number I would use to submit my claims?
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