SERVICE TERMS

Standard Fees

A schedule of fees is available upon request at the office. The attached flyer has pricing included and is subject to change. Estimates are available for direct pay lab and medical services. Please note that labs may have a secondary test that we do not anticipate and could result in an additional fee. Please note that if the nature of your appointment changes during your visit, the charges for your visit may not be the same as your estimate.

Financial Policy

FINANCIAL POLICY: We expect payment for co-pays or out-of-network plans at the time of service and permission to charge card on file for services received by patients with high-deductible plans. All additional charges after adjustments by insurance company will be charged to the card on file at the time the claim clears through insurance and we receive an Explanation of Benefits or Remit report. Appointments not canceled within 48 hours may be charged a $100 cancellation fee. We provide a courtesy digital invoice sent to your email on file after your claim has been cleared. Mailed invoices may incur a $5 processing fee per invoice. Your invoice may be subject to a $25 late fee if your service is not paid after the courtesy 30 days from when your claim is processed or from the date of your visit. To avoid late fees, patients are requested to have an HSA, HRA, FSA, or credit card on file for convenient automatic payment. 

 

Most services are eligible for coverage by HSA, HRA, or FSA card including certain services when ordered by a physician (ie., lifestyle monitoring if recommended by a physician, or special lab tests if ordered by a physician) including bundled services. We recommend you verify all charges with your insurance professional. 

Understanding Your Benefits

We strive to inform patients of anticipated insurance coverage of services, however specific benefits depend on type of plan. We are not licensed to provide guidance on your insurance plan. Below is a general overview of how insurance plans typically work. It is the patients' responsibility to check with their insurance company about the benefits for their specific plan.

Medicare B covers 80% of Evaluation and Management services with 20% coinsurance payments made by supplemental Medicare insurance plans (Plan F (no deductibles), Plan G (Medicare annual deductible, and supplemental plan deductible), and Plan N (must meet deductible and could have copay). Medicare patients may be required to sign an ABN for a specific service, lab draws or optional services. Some specialty labs are covered by Medicare B but not Medicare Advantage. We collect co-pays for Medicare Advantage plans at the time of service. Chronic Care Management and Remote Patient Monitoring are Medicare B and Medicare Advantage programs are subject to co-insurance or annual deductible.

 

Commercial carriers who are compliant with the Affordable Care Act cover preventive services such as annual physical or lifestyle health counseling and annual screening labs. Medical services for a problem or chronic disease are subject to copay, coinsurance, or deductibles.  Copays are collected on the day of service. Coinsurance and deductible are collected when your insurance company has processed your claim and charged directly to your card on file. 

 

Fair market plans (often sponsored by a private company), Marketplace plans (ie., Caresource), and non-ACA commercial carriers (ie., Freedom Life) vary widely. Marketplace plans provide one preventative visit per year and may cover lifestyle counsel. We will do balance billing as legally permitted for services not covered by your insurance or deemed outside their policy coverage. 

Other Terms: If you are a direct pay/cash pay patient, you must let us know before your appointment. Please share the nature of your visit so we may provide you with a cost estimate for your service. In general, we bill at $250 per hour for an appointment with a physician. 

We charge sitting fees, duplicate report fees, telephone calls as allowed by insurance, EHR photos and patient/physician communication as allowed by insurance, and for consultations required in complex situations. 

If there is a credit due, we will apply to a future service unless you request a credit due sooner. Any credit balance due to a patient at the end of the year will be sent to the patient in the form of which it was received (ie., credit card) when possible. If we cannot provide credit back from the credit card used, then we will deduct the credit card service charge to your refund.