Billing Policy Agreement

Insurance Billing

We accept most major commercial insurance plans and Medicare.

As a courtesy, we will submit claims to your insurance carrier. However:

• Insurance verification is not a guarantee of payment.
• Coverage is determined solely by your insurance company.
• Authorization approval does not guarantee full payment.
• Patients are responsible for understanding their insurance benefits, including deductible, copayment, coinsurance, and coverage limitations.

Patient Financial Responsibility

You are financially responsible for:

• Deductibles
• Copayments
• Coinsurance
• Non-covered services
• Services deemed not medically necessary
• Denied claims for any reason

If your insurance denies payment or applies charges toward your deductible, the remaining balance becomes your responsibility. Balances are due upon receipt of statement unless prior arrangements have been made.

Self-Pay Patients

Self-pay rates apply to:

• Patients without insurance
• Services not covered by insurance
• Patients choosing not to use insurance

Self-pay fees are due in full at the time of service.

Non-Covered Services

Certain services may not be covered by insurance, including but not limited to:

• Weight loss programs
• IV hydration therapy
• DOT physicals
• Employment physicals
• Certain laboratory services
• Wellness procedures

Patients are responsible for full payment of non-covered services.

Spravato Treatment Policy

Spravato treatment requires insurance authorization and medical necessity criteria.

Even with authorization:

• Coverage is not guaranteed.
• Deductibles and coinsurance may apply.
• Medication and monitoring charges may be billed separately.

Patients remain financially responsible for any portion not paid by insurance.

Payment Policy

Payment is due at the time of service for:

• Copayments
• Outstanding balances
• Self-pay visits

We accept cash, credit/debit cards, and approved electronic payments. Returned checks are subject to a processing fee.

Missed Appointment & Late Cancellation Policy

We require at least 24 hours’ notice to cancel or reschedule appointments.

Appointments canceled with less than 24 hours’ notice or missed without notification may result in a cancellation fee. Repeated missed appointments may result in discharge from the practice.

Collection Policy

Accounts unpaid after reasonable attempts at collection may be referred to a third-party collection agency. The patient agrees to pay reasonable collection costs and fees where permitted by law.