We are dedicated to providing the best possible care for you, and we want you to completely understand our financial policies to avoid any future misunderstandings.
Treatment Plan- It is very important to follow the schedule outlined in the prescribed treatment plan. Missed appointments and treatment gaps slow the healing process and may increase the number of treatments required. In this case, you will be responsible for the cost of the extra appointments beyond those outlined in the prescribed treatment plan.
Insurance Benefits- Benefit estimates given by your insurance company are no guarantee of payment, and your portion may be different from what we were told when we verified coverage. In this case, we will either refund you the excess or invoice you the difference. Insurance Co-Pay & Deductibles- When your insurance company specifies a co-pay or deductible; this payment is due at the time of service unless arranged otherwise with us.
Insurance Filings- As a service to you, we will file your insurance claim, if you assign the benefits to us so that your insurance company can pay us directly. We will also follow up for you, but if your insurance company does not pay the claim within a reasonable period, you are responsible for payment.
Self-pay- If you do not have insurance, or if we cannot verify your coverage, payment is due at time of service unless arranged otherwise with us.
Returned Checks- We will charge a fee of $25 for all checks returned unpaid.
Collections- if your account is ever assigned to an attorney or outside agency for collections or litigation, SpinalWorks shall be entitled to reasonable attorney's fees and the cost of collections. Missed Appointments- As a way to honor everyone's schedule, we reserve the right to charge a $25 fee for appointments missed without a one day advance notice.
Credit Payments- We gladly accept Visa and MasterCard, and offer CareCredit for treatment financing. Other credit arrangements may be possible, please ask if these are of interest.
Refunds- We will normally make full refund of any unapplied funds within .30 days of cancellation in case of an unfinished prepaid treatment program. The credit balance is calculated as the amounts paid, less the list price of any treatments received to date.
Your Agreement- I have read and understand the practice's financial policy. I agree to be bonded by its terms as indicated by my signature below. I authorize the release of any information necessary to determine liability for payment and reimbursement for any claim.
I hereby authorize the doctors at SpinalWorks to treat my condition as he deems appropriate. It is understood and agreed the amount paid to Health Works Spine & Sport, for x-rays is for the examination and interpretation of the X-ray negatives and will remain the property of the clinic, being on file where they can be seen at any time while patient at this office. The patient also agrees that he/she is responsible for any bills incurred at Health Works Spine & Sport.