- Proof of active Insurance and photo ID are required for all patients. We will ask to make a copy of your ID and insurance card for our records. Providing a copy of your insurance card does not confirm that your coverage is effective or that the services rendered will be covered by your insurance company.
- We require to retain copy of your Credit Card information in our secured location. At NO point will your card be charged without your knowledge.
- It is your responsibility to provide current and accurate information, including any updates or changes in coverage. Should you fail to provide and promptly update accurate insurance information, you will be financially responsible subject to the requirements of your insurer.
- We will attempt to confirm your insurance coverage prior to your treatment. In the event your insurance declines coverage, you will be notified and offered a cash option that is owed in full at the beginning of each month. Upon request, we will provide a receipt of service for you to submit to your insurance for possible reimbursement.
- Fees are payable when services are rendered. We accept cash, credit cards, and pre-approved insurance for which we are a contracted provider.
- It is your responsibility to know your own insurance benefits, including if your referring provider is contracted with said insurance, your covered benefits, any exclusions, and if pre-authorization is required.
- If any copayment(s), deductible(s), or other cost sharing is required by your insurance, you will be billed for any amount determined to be your responsibility. This process generally takes 30-45 days from the time the claim is received by the insurance company.
- Please understand some insurance coverages have Out-of-Network benefits that have co-insurance charges, higher co-payments and limited annual benefits. If you receive services as part of an Out-of-Network benefit, your portion of financial responsibility may be higher than the In-Network rate.
Charges for Health Coaching Services
We are excited to have you participate in our health coaching program. Our health coaching and clinical staff are dedicated to your health and to providing care that exceeds your expectations. As stated above, should your insurance deny any of the preventative services provided by our staff, you will be responsible for payment.
Below is an example of charges you would be held responsible for should your insurance deny coverage.
|Initial visit with Health Coach (1 visit)||$65.00|
|Weekly health coaching visits (3 visits)||$40.00 - $65.00|
|Total:||$185.00 - $225.00|
Definition of a “No-Show” Appointment
We define a “No-Show” appointment as any scheduled appointment in which the patient either:
- Does not arrive to the appointment
- Cancels with less than 24 hours’ notice
- Arrives more than 10 minutes late and is consequently unable to be seen
Impact of a “No-Show” Appointment
“No-show” appointments have a significant negative impact on our business and the healthcare we provide to our patients. When a patient “no-shows” a scheduled appointment it:
- Potentially jeopardizes the health of the “no-showing” patient
- Is unfair to other patients that would have taken the appointment slot
- Disrespects the provider’s time
To Avoid Getting a “No-Show” Charge
- Confirm your appointment
- Arrive 5-10 minutes early
- Give 24 hours’ notice to reschedule an appointment
Consequences of “No-Show” Appointments
1st No-Show – Letter/Email sent to patient reminding them of the policy
2nd No-Show – Letter/Email sent and patient billed appropriately (see below)
- $25.00 per 25-30 min. (weekly visit) appointment slot
You agree that it is your responsibility to notify the Coach of the need to cancel a visit 24 hours in advance of the scheduled call/visit. If you are 10 or more minutes late for a schedule visit, the visit will be cancelled and considered a no-show. Coach will attempt in good faith to reschedule missed visits.
Monthly Subscription Terms
Your subscription will be renewed automatically and billed to your credit card account at the beginning of each subscription period until you cancel the service. You may cancel at any time by following the procedure described in our Cancellation Policy below. The monthly subscription plans are renewed automatically on 30-day intervals.
Cancellation to subscription requests must be submitted by email to email@example.com at least 3 business days before the renewal date. Cancellation notice sent to firstname.lastname@example.org will terminate future use of the service and automatic renewals will end. There are no refunds.