Patient Financial and Payment Policy

Natalie Kitamura LLC

DBA 'Imi Ola Health and Wellness Clinic

1314 S. King Street, Suite 624, Honolulu, HI 96814

(808) 551-8947

No show policy

We schedule our appointments so that each patient receives the right amount of time to be seen by our physicians and staff. That's why it is very important that you keep your scheduled appointment with us and arrive on time. As a courtesy, and to help patients remember their scheduled appointments, Dr. Quinio's office sends reminders (text, email, and/or phone calls) several days in advance of the appointment time and the day before. If your schedule changes and you cannot keep your appointment, please give us at least 24 hours notice and call ahead so we may reschedule you. If you do not cancel or reschedule your appointment with at least 24 hours notice, we may assess a standard $50 "no-show" service charge to your account. This "no-show charge" is not reimbursable by your insurance company. You will be billed directly for it. If you are more than 5 minutes late you will be asked to reschedule, and the no show policy and fee will take effect. After three consecutive no-shows to your appointment, our practice may decide to terminate, and you will receive a letter indicating the end of your care at our practice. I understand the "no-show" policy of Natalie Kitamura LLC DBA 'Imi Ola Health & Wellness Clinic and agree to provide a credit card number, which may be charged $50 for any no-show of a scheduled appointment. I understand that I must cancel or reschedule any appointment at least 24 hours in advance in order to avoid a potential no-show charge to the credit card provided.

Patient Responsibility

You must provide us with a current insurance card and billing information. Your insurance policy isa contract between you and the insurance company. It is your responsibility to know your insurance benefits and pay any remaining portion due after insurance processes your claim. We will also verify coverage prior to your office visit. Co-pays are due at the time of service. A $30.00 returned check fee will be charged for checks returned due to insufficient funds. I understand that am financially responsible for all charges regardless of third-party involvement. I agree to pay any deductible, co-insurance, copay, or any service(s) deemed a "noncovered benefit" by my insurance company. I understand that failure to pay outstanding balances within 90 days of receiving my first statement will result in the submission of my account to an outside collection agency. the debt remains after transfer to our outside collection agency, the debt may be reported to credit bureaus and your credit rating may be affected. In addition, failure to pay delinquent account balances may result in termination of care from our practice.