Regarding Insurance:
If your intent is for Heading Health to submit a claim to your insurance provider for the care and treatment you receive with one of your providers, you must provide us with your current insurance carrier’s information, including providing a copy of your insurance card. It is your responsibility to ensure that you provide Heading Health with accurate insurance information and notify us immediately if there is a change in your insurance information. If your insurance coverage cannot be verified at time of services, you will be responsible for the full payment of services received.
If we are enrolled with your insurance plan:
· If your insurance requires a treatment referral from your Primary Care Physician, you are responsible for obtaining the treatment referral to our office prior to scheduling your treatment. Failure to obtain the required referrals may result in a denial of payment from your insurance carrier, thereby making you solely responsible for the entire balance owed for your treatment.
· If your insurance requires you to share financial responsibility (i.e. Copayment obligations, patient responsibility, deductibles, and coinsurance) for your treatment, your financial responsibility will be collected at time the treatment was rendered. Regardless of the amount that is collected at the time of your treatment, you must pay all amounts dictated by your insurance carrier as your financial responsibility and will be billed for any additional monies owed.
If we ARE NOT enrolled with your insurance carrier:
· You will be required to pay in full for your treatment at the time of your visit. Requests for an itemized receipt for the treatments rendered must be requested in advance to the practice’s office staff when the appointment is made.
· As a courtesy, we will submit a claim for payment of treatments rendered to your insurance carrier unless you direct us not to. As an out of network provider, we will request that any payments made by your insurance carrier will be made directly to you.
If you are not sure whether we are an enrolled provider with your insurance carrier, please make inquiry with our office staff or contact your insurance carrier to verify network participation.
Cancellation/No-Show Policy:
Appointment times are scheduled and reserved just for you. If you know there is a problem with your appointment time, please call to reschedule as soon as possible. We require at least 48-hours’ notice for cancellations to avoid being charged a no-show/late fee.
If you do not show up to your scheduled appointment or call to cancel within 48-hours of your appointment, you will be charged a $100 fee for each occurrence. More than three no shows could result in being discharged as a patient from the practice. If you call after business hours, please leave a message indicating that you need to cancel or reschedule your appointment.
Forms Fee:
There is a fee of $25 per form for completing disability and/or insurance forms. Payment for generating these forms is due with your request and the form is provided to our office. Please allow up to 5 business days for the completion of any forms.
Medicare Patients:
You must provide us with a copy of your Medicare identification card, as well as a copy of any secondary or supplemental insurance you have that may provide coverage for your treatment (where applicable).
You will be required to satisfy your annual $198.00 Medicare deductible and pay your 20% coinsurance if you do not have a secondary or supplemental insurance. If you have provided us with a copy of your Medicare identification card, and other secondary or supplemental insurance cards, we will not require payment at the time of your treatment as we will be submitting claims for payment to those carriers. You will be billed for any balance owed that your insurance carriers have determined to be your financial responsibility.
Medicaid Patients:
We are not contracted with any type of Medicaid Plans. If you have Medicare as your primary insurance and Medicaid as your secondary insurance, unfortunately, we are unable to treat you.
Regarding Lab Charges:
There will be an additional fee charged by an outside lab for the processing of any labs taken in our office. The professional component of reading/interpreting the results will also be billed separately by an outside lab.
About non-covered services:
A service considered by your insurance carrier to be non-medically necessary (i.e. cosmetic or otherwise) will not be covered by your insurance policy. You will be required to pay in full for these types of services in advance of your treatment unless arrangements have been made with our office administrator.
Thank you for taking the time to read and understand our practice’s financial policy. We are here for any questions or concerns you may have.
I attest that I have read the Financial Policy and was provided an opportunity to ask any questions that I had about this policy. I further attest that I understand and agree to all the terms and conditions found in this policy.