Financial Policy for Patient Care Services

Whole Health Center wants to provide the most efficient and affordable health care services, so it is necessary for us to have a financial policy stating our requirements for timely payment of services and products provided by our office. We welcome the opportunity to discuss any aspect of our financial policy.

To help us help you, please:

1. Provide us with accurate and updated information on yourself and your insurance company.
2. Pay at the time of service for your entire balance.
3. Discuss your account balance only with the front office staff. It is important for practitioners to be allowed to provide patient care. If the front office staff cannot help you, do not hesitate to contact the office manager.

Insurance Patients:

We are happy to file insurance claims as a courtesy to you. It is your responsibility to see that the claims are paid. As stated by your insurance company: “Verification of benefits is no guarantee of payment.” If you have insurance and we file with your carrier for you, you will be responsible for all charges not paid by the insurance company. The balance due is your responsibility if we have not received payment from your insurance company within 60 days.

Whole Health Center sends claims with procedure codes to the insurance companies. Your insurance company then chooses the “reasonable and customary” amount to apply to your visit. Your insurance plan is a contract between you and your insurance company, therefore any amount applied toward your deductible must be paid in full.

By signing this financial policy:

1. You are authorizing Whole Health Center, Acupuncture Associates, their providers, and employees to release any necessary information related to this visit and all future visits to your insurance company for the purpose of claim(s) payment. You are giving authorization to submit your claims without obtaining your signature on each and every claim submitted.
2. You are authorizing your insurance company and your medical provider to release your medical records to Whole Health Center and Acupuncture Associates for the purpose of claim(s) payment.
3. You are authorizing your insurance company to pay any medical benefits and all future claims for services provided by our office directly to Whole Health Center and/or Acupuncture Associates.
4. You are giving Whole Health Center and Acupuncture Associates the right to speak with your insurance company, any third party insurance company, and your attorney regarding your claims and bills.
5. You agree that a photocopy of any document is as valid and effective as the original.

Whole Health Center, Acupuncture Associates, and its providers accept worker’s compensation and auto accident insurance. We require that a lien signed by the patient and any attorneys is on file when applicable. Whole Health Center and its providers are willing to extend the expectation of payment within 60 days for worker’s compensation and auto accident insurance when Med-Pay is not available.

If you prefer that we do not file insurance claims for you, you may pay the time-of-service discounted rate and send the claim to your insurance carrier. If you choose to submit your own claims, we will provide you with a super bill, but cannot assist you in filing your claims.

Self-Pay Patients: If you do not have insurance or our services are not covered by your insurance company, you will be considered a “self-pay” patient. Family plans and discounts must be applied at the time of service and cannot be back-dated. If you have a financial hardship, an application for financing or a financial hardship discount must be completed before or at the time of service. It is important to Whole Health Center that you become well now, even if we need to work with your financial budget.

Cancellation Policy:
In order to provide you with the best care, please arrive 10 minutes prior to your appointment—late arrival may result in cancellation. We require 24 hours’ notice of cancellation or you may be charged a fee. Please remember that failure to appear for your appointment prevents others from receiving care.

Finance Charges:
Failure to pay for services and products provided by our office will result in a finance charge. If we need to forward your account over to a collections agency for further legal action, you will be responsible for the entire balance on your account plus any collection fees. The responsibility for payment of medical services for you or your dependents is yours; due and payable at the time services are rendered unless financial arrangements have been made. You are responsible for all costs of collection, including attorney fees, collection fees of 25% of the principal balance, and court costs. Any unpaid balance will be assessed interest at the rate of 18.00% (1.5% monthly).

Payment Options:
For your convenience, we are happy to keep your credit card on file and secured for payment of all services and products.

Please ask the front desk if you would like to apply for Care Credit financing and/or financial hardship.

If you would like to keep your credit card on file in a secured location in our system, please tell the front desk.

Healthy People are Happy People