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  • New Patient Policies

  • Cancellation & Rescheduling Policy

    Our goal is to provide quality individualized patient care in a timely manner. No-shows, late shows and cancellations inconvenience those individuals who need access to medical care. We would like to remind you of our policy regarding missed appointments.
  • Cancellation of an Appointment
    In order to be respectful of the needs of other patients, please be courteous and call our office promptly if you are unable to show up for an appointment. This time will be reallocated to someone who is in need of treatment. If it is necessary to cancel your scheduled appointment, we require that you call at least 48 hours in advance. Appointments are in high demand, and your early cancellation will allow another patient access to timely medical care.

    How to Cancel Your Appointment
    To cancel your appointment, please call the office at (860)228-1287. If you do not reach the receptionist, you may leave a detailed message on our voice mail. If you would like to reschedule your appointment, please leave your name and phone number. We will return your call promptly.

    Late Cancellations
    A cancellation is considered to be late when the appointment is cancelled without a
    48 hour advance notice. 

    No Show Policy
    A “no-show”, is a patient who misses an appointment without cancelling it. A failure tobe present at the time of a scheduled appointment will be recorded in the patient’s chart as a “no- show”. This includes arriving 15 minutes after your scheduled appointment.

    Insurances do not cover no-show or late cancellation fees so you, the patient, will be responsible for the payment. If you incur 2 or more no-shows or late cancellations, you may be discharged from the practice.

    If you are charged a no-show or late cancellation fee and you believe that an error may have been made or that you deserve special consideration, please provide an appeal to us in writing for consideration.

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  • Patient Financial Responsibility Form/ Self-Pay Waiver

    Thank you for choosing TAO Center for Vitality, Longevity & Optimal Health for your medical needs, we are committed to providing you the highest quality healthcare. We ask that you read, make the appropriate selection, and sign this form to acknowledge your understanding of our patient financial policies.
  • Patient Financial Responsibilities

  • The self-pay cost for Dr. Myriah Hinchey’s services are as follows:

    • First Appointment: $997
    • Second Appointment: $997
    • High-Medium Complexity Appointments: $497
    • Low Complexity Appointments: $297

    __________

    The self-pay cost for Dr. Houser's common services are as follows:

    • New patient appointment: $390.00
    • Established patient appointment, medium- high complexity: $325.00
    • Established patient appointment, low complexity: $197.00
    • Acupuncture appointment: $85.00

    All fees for the self-pay service must be paid on the date of service.

    By my signature below, I acknowledge that I have read and understand the above and have been given the opportunity to ask questions. I confirm that I am the patient, or the patient’s duly authorized representative.

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  • Advanced Medicare/Medicaid Beneficiary Notice

  • Dear Patient,

    Medicare and Medicaid do not pay for Naturopathic Medicine, nor do they pay for blood tests ordered by Naturopathic Physicians. Medicare and Medicaid pay only for services performed or ordered by Medicare-certified providers, and Naturopaths are not Medicare-certified.

    Patients are responsible for knowledge of their insurance benefits as well as being fully responsible for all charges regardless of insurance coverage.

    Your Naturopathic Physician may order blood work/labs that will require the signature of a Medicare-certified Physician such as your primary care physician. It is up to you to obtain that signature. If you do not believe your insurance will cover a procedure, you have the right to decline the procedure prior to it being performed.

    This notice gives our opinion, not an official Medicare decision.

    Signing below means that you have received and understand this notice.

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  • Telehealth Informed Consent

  • I,         , hereby consent to participate in telehealth with my provider at TAO Center for Vitality as part of my treatment. I understand that telehealth is the practice of delivering clinical health care services via technology assisted media or other electronic means between a practitioner and a client who are located in two different locations.

    I understand the following with respect to telehealth:

    1. I understand that I have the right to withdraw consent at any time without affecting my right to future care, services, or program benefits to which I would otherwise be entitled.
    2. I understand that there are risks, benefits, and consequences associated with telehealth, including but not limited to, disruption of transmission by technology failures, interruption and/or breaches of confidentiality by unauthorized persons, and/or limited ability to respond to emergencies.
    3. I understand that there will be no recording of any of the online sessions by either party. All information disclosed within sessions and written records pertaining to those sessions are confidential and may not be disclosed to anyone without written authorization, except where the disclosure is permitted and/or required by law.
    4. I understand that the privacy laws that protect the confidentiality of my protected health information (PHI) also apply to telehealth unless an exception to confidentiality applies (i.e. mandatory reporting of child, elder, or vulnerable adult abuse; danger to self or others).
    5. I understand that if I am experiencing a physical ailment and/or a mental health crisis that cannot be resolved remotely, it may be determined that telehealth services are not appropriate, and a higher level of care is required.
    6. I understand that during a telehealth session, we could encounter technical difficulties resulting in service interruptions. If this occurs, end and restart the session. If we are unable to reconnect within ten minutes, please call the office at (860) 228-1287 to discuss since we may have to re-schedule.
    7. I understand that my provider may need to contact my emergency contact and/or appropriate authorities in case of an emergency.


    I have read the information provided above and I understand the information contained in this form.

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  • I agree to pay my balance in full at the time of each visit or treatment, including fees for services, cost of supplements and remedies, cost of laboratory tests, administrative fees as well as other applicable fees. I understand that it is my responsibility to know the extent of my insurance benefits and if the policy I hold does not cover Naturopathic Medicine, I am responsible for the cost of my visits. We will bill your insurance for you if it is accepted at TAO; however, the patient is required to provide the most correct and updated information regarding insurance. Patients are responsible for payment of co-pays, co- insurance, deductibles, and all other procedures or treatments not covered by their insurance plan.

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  • I hereby authorize TAO Center for Vitality, Longevity; Optimal Health LLC to directly receive payment of pertinent insurance benefits; to release information including protected health information to insurance companies and other related third parties as needed in relation to the filing for or collection of payment for provided services; to obtain records from other sources as needed in relation to patient diagnosis and treatment; and to convey information through various means as needed in accordance with the Notice of Privacy Practices, a copy of which was made available to me.

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  • In the event that my account goes past due beyond 90 days, I understand that I will incur a 15% interest fee per month. And if my account should go to collections, I will owe a 29% collections fee in addition to the interest fee.

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  • Due to the high quality standards we hold our supplements up to, there are absolutely NO returns on ANY supplements. I understand that there are absolutely no returns on any supplements under any circumstances.

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  • I have read and understand the cancellation and rescheduling policy.

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  • Secondary Insurance Reimbursement
    TAO’s Policy is to file the secondary insurance one time.  As a courtesy to you the patient, our billing department will file your claim to your secondary insurance company. If there has been no response from your secondary insurance company within 60 days of your date of service or the payment is denied, the balance is due immediately by you, the patient.

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  • Court Action/Legal Fees Policy

  • Clients and Patients are discouraged from having their therapist or doctor subpoenaed or having them provide records for the purpose of litigation. Even though you are responsible for the testimony fee, it does not mean that their testimony will be solely in your favor. They can only testify to the facts of the case and to their professional opinion.

    We will request a minimum of 72 hours’ notice of any Court appearance so that schedule changes for clients/patients can be made within a reasonable time frame.
    Please note: If a subpoena or notice to meet attorney(s) is received without a minimum of 72 hour notice there will be an additional $250 express charge.

    The fees for court appearances are as follows:

    • $1400.00 per day.
    • In addition to the court appearance or testimony, there is a charge for a minimum of three (3) hours preparation for testifying ($525.00 minimum).
    • In order to ensure the availability of the practitioner, a deposit of $1400.00 must be paid at least 72 hours (3 business days) in advance of the court date
    • Written court summary or expert report can be provided for $200.00 per hour, 2 hour minimum.


    A retainer of $1400 is due at least 72 business hours before the scheduled court appearance. The remainder of the costs will be billed after the court appearance and will be due upon receipt.

    In the event of cancellation of the court appearance, the deposit will be forfeited unless cancellation is received at least 72 hours (3 business days) before the scheduled court date.

    Payment is expected upon receipt. If a payment is not made within a week of invoice being sent out, your credit card on file will be charged. A zero balance will need to be kept at all times.

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