Insurance Benefits and Financial Responsibility Agreement
Thank you for choosing Atlas Chiropractic Health Center. We appreciate the opportunity to serve you and pledge to provide you with the very best medical care. The following contains information regarding our insurance benefits and financial responsibility policies. It is important that you read and understand this information prior to and during the duration of your treatment with us.
Commercial Insurance Carriers:
1. As a courtesy, we will verify your benefit eligibility, however, since your insurance coverage is a contract between you and your insurance company, it is important that you understand the terms set forth by them regarding your benefits. It is your responsibility to contact your carrier prior to treatment if you have any questions or concerns regarding your coverage.
2. You are responsible for deductibles, co-payments, co-insurance payments or any other patient responsibility determined by your insurance carrier which is not otherwise covered. You are also responsible for knowing and tracking your total allowed visits per coverage term as well as if a prior authorization is required.
3. You are responsible for knowing the terms of your insurance policy, including, but not limited to physical and occupational therapy coverage. You will be responsible for any and all charges in full for the following scenarios:
a. Your health plan requires a prior authorization or referral from a physician before receiving treatment at Atlas Chiropractic Health Center and has not been provided by you
b. You receive services in excess of:
i. Your referral or authorization
ii. Your allowed visits per coverage term
c. Your health plan determines that the services you received at Atlas Chiropractic Health Center are not medically necessary and are therefore not covered by your plan
d. Your health plan coverage has expired, and you have not provided updated coverage information
4. You are required to provide us with all required information to bill your plan prior to your first appointment. If we are unable to verify your eligibility or benefits by the time of service, you will be considered a self-pay patient. Self-pay visits are expected to be paid in full at the time of service. Once verified information is provided, we will submit your claim and refund you once we have been paid by your carrier. You must notify us as soon as possible regarding any changes to your insurance coverage. Failing to do so could result in unpaid claims, and you will be responsible for the total balance of the unpaid claim. Atlas Chiropractic Health Center does not accept responsibility for incorrect information provided by you or your insurance carrier regarding your insurance benefits or other plan information.
Any information we communicate to you has come directly from your carrier. Discrepancies should be addressed directly with them.
5. Billing statements are emailed monthly and can be expected to be received approximately 20-30 days after your insurance has processed a submitted claim. Please add email@example.com to your list of acceptable contacts. We are not responsible if our emails are sent to you spam or trash boxes. You must notify us of any errors or objections to your billing statement within 30 days of the statement date, otherwise the information will be considered accurate and any fees and expenses for services provided will be your responsibility.
6. Payment of your account balance is due within 30 days of the statement billing date. Payments can be made online, in person, or via mail. You can conveniently pay by visiting our website or making payment by PayPal, check, cash and all major debit and credit cards are also accepted. It is your responsibility to notify us of any address changes. Not receiving a bill due to inaccurate information on file is not an excuse for nonpayment.
7. All self-pay services and co-pays are required to be paid in full at the time of service. All self-pay patients without insurance in accordance with the law will be given a good faith estimate.