Office Policy Regarding Your Financial Obligation

The purpose of this notice is to clarify your financial responsibility so that we can devote our efforts to helping you get the best results possible with the least inconvenience and expense.

Forms of Payment

In order to receive the “Time of Service” fee, the patient must pay at the time the service is rendered or the end of the business week with prior approval. We accept cash, check, check card or credit card with Visa / MasterCard affiliation.

Insurance/Contract Service/Third Party Pay

Other options are available if your care is covered by group health insurance, Worker’s Compensation, managed care, Medicare, personal injury or the result of an automobile accident.

All professional services are rendered and charged to the patient receiving care and not to the insurance carrier. We will, as a courtesy to you prepare and submit a standardized claim form, reports or other documents to help you receive a reimbursement from a third party. Likewise, we will comply with Pennsylvania Law regarding Worker’s Compensation and Auto Accident claims.

This office will not become involved in disputes with your insurance carrier regarding deductibles, co-payments, covered charges, secondary coverage, usual and customary schedules, etceterasm other than to supply factual information.

All patients with insurance must pay the deductible in full because we do not know how quickly other physicians will submit their claims. Any overpayment will be applied to your accounr for credit toward future care. Any underpayment will be “balance billed” with a copy of the insurers’ explanation of benefits form. A payment on the balance due is expected within 10 days of the invoice date. Thos policies with a co-payment requirement are expected to be paid at the time of service.

Return checks are subject to a $24.00 fee. Balances older than 30 days will accrue interest charges or 1.00% per month plus any legal or collection fees.

Special Arrangements

We have never denied anyone the benefits of chiropractic care because ot their inability to pay our published fees. If financial hardship requires and Individual Consideration Contract, please allow us to present an alternative plan.

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