Financial Responsibility

• For insurance covered patients: 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.
• If we collect and retain a copy of your Credit Card information, as part of your program, it will be in our secure location. We have the right to charge your credit card if you violate our policy as dictated below in our Insurance Based Program Terms & Conditions
• 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 your referring provider is contracted with.
• 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.

Out-of-Pocket (OOP) Program Terms & Conditions

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 Policy

Cancellation to subscription requests must be submitted by email to info@inhealthonline.com at least 3 business days before the renewal date. Cancellation notice sent to info@inhealthonline.com will terminate future use of the service and automatic renewals will end. There are no refunds for any of our OOP programs.

Insurance-Based Program Terms & Conditions

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. If you enter the insurance-based program, should your insurance deny any of the preventative services provided by our staff, you will be responsible for payment.

Employer-Based Program Terms & Conditions

As a covered employee of your employer-sponsored program we will not charge you, the patient, a no-show or late-cancel fee, however, out of respect to our coaches and business we do reserve the right to cease services after multiple violations of the no-show or late-cancel policy.

“No-Show” Policy

Definition of a “No-Show” Appointment

We define a “No-Show” appointment as any scheduled appointment in which (you) the patient either:

• Does not arrive to the appointment
• Cancels with less than 24 hours’ notice (“Late-Cancel”)
• Arrives more than 5 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” to a scheduled appointment it:

• Potentially jeopardizes the health and outcomes of the “no-showing” patient
• It is unfair to other patients that could have taken the appointment slot
• Disrespects the provider’s time

To Avoid Getting a “No-Show” Charge

1. Confirm your appointment
2. Arrive 5-10 minutes early
3. Give at least 24 hours’ notice to reschedule an appointment

Consequences of “No-Show” Appointments

Insurance-Based Patients:

• $35.00 per 25-30 min. (weekly visit) appointment slot

OOP Patients:

Any “no-show”, as defined above, will count as one of your visits in your given package and you will forfeit that visit.

You agree that it is your responsibility to notify the Coach of the need to cancel a visit at minimum 24 hours in advance of the scheduled call/visit. If you are 5 or more minutes late for a scheduled visit, the visit will be cancelled and considered a no-show. If you consistently reschedule appointments with your Coach we retain the right to cease services.

INHEALTH MEDICAL SERVICES

info@inhealthonline.com 1801 Century Park East 24th Floor Los Angeles, CA 90067 888-219-5299