Thank you for choosing Summit Sports and Spine! At Summit, we are committed to providing you with the best possible care. Below you will find our office and financial policies.
Our mission at Summit Sports and Spine is to provide accurate diagnosis related to all musculoskeletal complaints and provide specific treatment interventions to resolve them as quickly as possible. Our goal is to empower and educate our patients to become active participants in their care and helping to resolve their injuries.
Office Policies
- We require 24 hours advance notice for cancellation.
- No Show or Late Cancellation (less than 24 hours’ notice) will result in a fee of $75
- Please contact our office immediately if you will be more than 10 minutes late for your appointment. If you are more than 20 minutes late with no notice for your appointment your account will be subject to the “No Show” fee listed above.
- Please notify our staff if you have any change in your health concerns such as a new injury, work related injury, or an automobile accident. This will allow us to schedule your appointment accordingly giving the Doctor appropriate time to assess your new condition.
- We reserve the right to release you from care at our office if you display a consistent pattern of cancelled or no-show appointments. This may occur as well if you act in a way that is inappropriate such as consistently rude to the staff or doctor, not following through on your rehab, beligerent, sexually inappropriate comments etc. In the instance a patient is released for care at our office, any balances owed are to be paid in full by the patient within 5 business days unless special arrangements are made. If balances owed are unpaid, a 2% per month service charge will be incurred until the balance is paid in full.
- If you bring children with you to your appointment, you are responsible for their actions at all times. We love children and are happy to treat them, they just need to remember we have patients seeking us for high-level professional care. If your children’s behavior is disruptive to our clinic/patients/work environment we reserve the right to cancel your appointment and you will be charged for that appointment in full.
- We advise our patients to schedule multiple appointments in advance. This will help insure a convenient appointment time for you, as well as provide you with the highest possible level of care.
- Treatments at this office include chiropractic, physical medicine, and laser treatment. We are a CASH BASED practice - not taking insurance. However our billing practices are similar and the doctors and therapists in this clinic bill only for treatment rendered per guidelines as an insurance preferred provider. For physical medicine, services are billed according to the units listed below:
1-2 units = 8-22 minutes 2 units = 23-37 minutes 3 units = 38-52 minutes
- If there is a six month lapse between chiropractic treatments, the next appointment will automatically be scheduled as a re-examination. If a 3 year lapse or more has occurred between chiropractic treatments, the next appointment will automatically be scheduled as a new examination.
- Necessary referrals required for Chiropractic care, Massage Therapy or any diagnostic studies are the sole responsibility of the patient.
- Supplements, pillows, braces, taping, laser, ozone, hyperbarics and other recommended products are generally not covered by your insurance carrier and are therefore your responsibility to pay for at the time of service. We have a no refund policy for all products sold. If a percentage of refund is deemed acceptable this will only be on a case by case basis.
Financial Policies
- We accept the following forms of payment: cash, personal checks, debit cards, and all major credit cards. NSF checks will be charged a service fee of $35 per occurrence in addition to the amount of the said check.
- It is the patient’s responsibility to make sure our office is notified immediately of any changes to your personal information or health insurance.
- Payments for all supplements and products, are due at the time of service. No exceptions.
- An insurance contract is between the patient and the insurance company. It is not this office’s obligation to enter into a dispute with any insurance company concerning the payment.
- You are ultimately responsible for paying via Cash, Check or Credit Card at the time of the visit - IN FULL.
- Insurance coverage is never guaranteed. If there are any problems between the insurance company and the patient, the latter may file a grievance directly with their insurance company. Your signature below acknowledges we do not take insurance and will not enter a discussion with them for your reimbursement for charges billed. WE WILL provide appropriate CPT and CMT codes in a super-bill that will enable the insurance to see what was provided in an accurate and forthwith manner for your reimbursement.
- The office/billing manager reserves the right to approve account balances on a case-by-case basis. Active monthly payments are required on any balances that are 30 days past due. Accounts with balances 30 days past due will be charged a service fee of 2% monthly until a payment is made.
- The following chart represents that minimum payment due for balances that are 30 days past due:
Balance
|
Required Minimum Monthly Payment
|
$0.00 - $299.99
|
$50.00
|
$300.00 - $649.99
|
$100.00
|
$650.00 +
|
$150.00
|
*Payments are subject to change depending on the circumstance
- Any account where no payment has been received for 60 days may be sent to a third-party collection agency. Any additional collection fees will be the responsibility of the patient.
- We do offer a time of service discount when services are paid in full at the time of the visit for patients and they are already built into our pricing plans.
Service
|
Amount Due at Time of Service
|
Initial Exam
|
250.00 (90 min) 190 (60min)
|
|
Re-examination
|
150.00 (30-40 min)
|
|
Chiropractic (Plans and Pkgs avail) |
Est Patient $50 / Packages vary |
|
Hyperbaric Oxygen Therapy (HBOT)
|
115 (Packages vary)
|
|
Ozone Therapy
|
55.00 (Packages vary)
|
|
Class IV Laser
|
50.00
|
|
Dry Needling |
|
45 |
|
- Medicare patients are fully responsible for non-covered services performed in our office. Medicare only covers manipulation of the spine. Medicare does not pay for Examination or Re-examination fees, supplements, products, ART, or laser treatment. Secondary, not supplemental, insurance may or may not pay for these non-covered services.
- We do accept payment from Flex Spend (FSA) and Health Saving Accounts (HSA). These payment methods also require payment at time of service. If your FSA or HSA does not allow you to pay at time of service, these situations will be handled on a case by case basis.
I acknowledge that I understand the policies as contained herein. By signing below I agree to the stated office and financial policies.