Thank you for choosing Central Baldwin Chiropractic Center. We want to provide the best care possible to you. Please understand payment for our services is part of your treatment and care, and this statement explains our policies and procedures in that endeavor. Knowledge of your individual insurance plan coverage remains your responsibility, therefore we urge you as a patient to check with your insurance company prior to any testing or treatment to be performed.
Our practice policy requires that prior to any services being rendered; all patients must sign the practice financial policy. In more recent years, it has been increasingly difficult to collect the fees rightfully due to the provider for services rendered, in good faith, to their patients. Central Baldwin Chiropractic Center deems it necessary to be very explicit in our financial policies of this practice. We ask that you please present the office with a form of payment to meet your obligations to your insurance provider and to your healthcare provider.
We thank you in advance for taking the time to review these policies. Please feel free to discuss any concerns or questions you may have with our billing staff or our practice manager. We would welcome the opportunity to assist you in your understanding the complexities of health insurance today.
We require the following before we can provide you care and treatment:
· Updated demographic and current insurance information
· Co-payment or payment for non-covered services
· Referral if required by your insurance plan
· If you are unable to present your current insurance card at the time of your appointment you will be asked to reschedule your appointment or pay for your service as a Cash-Pay Patient.
Missed or Cancelled Appointment Fees
· As a courtesy to our patients, your appointment will be confirmed by call or text the day prior to your appointment. Again, this is a courtesy reminder and there is no guarantee that the reminder system will be able to reach you. We ask that you pay special attention when speaking to the person who schedules your appointment as to the date and time of your appointment.
· 24 hour notice is required to cancel and reschedule all appointments. Failure to do so will result in a $25.00 “NO SHOW” fee for established patients.
· All balances, including NO SHOW fees, are due prior to any further services provided by our practice.
New Patient Appointments should be Cancelled 24 hours in Advance
· Failure to show for your NEW PATIENTS appointment will result in a $50.00 “NO SHOW” fee. This fee must be paid prior to scheduling another appointment. We realized that there may be extenuating circumstances in your lives which may cause you to miss an appointment; we do request a phone call to inform us of your inability to keep your appointment. Lack of cancellation denies the doctors ability to render care to another patient in your place.
Service charges may be made on the following:
· Re-Filing of insurance if incomplete or incorrect info given at time of appointment
· $40 for Returned Checks
· Failure to give proper cancellation notice of an appointment
· Balances that are greater than 60 days past due
Uninsured/Self Pay Patients
· All New Patient self-pay are required to pay $200.00 Deposit toward their office visit prior to being seen by the provider.
· All Established self-pay patients are required to pay $50.00 Deposit toward their office visit prior to being seen by the provider. Any charges above the will be collected at check-out.
· Medicare requires that we provide patients with a written notification whenever it is likely you will be responsible for the bill. The “ABN form” needs to be signed indicating your approval of services to be rendered or your denial of the services offered.
· Central Baldwin Chiropractic Center is not in the network but will file it for you.
· Please make sure that you have a full understanding of your benefits and what might be your responsibility if not covered by your insurance plan
· There is no phlebotomist available for blood draws in the office but we use Thomas and South Baldwin Hospitals.
· Any service(s) provided by a lab or hospital is a contract between you and that lab or hospital. Any dispute with that lab or hospital should be handled with that lab or hospital and is not the responsibility of the practice.
· The parent/guardian/adult accompanying a minor child is responsible for payment. Any child over 18 is legally an adult and is responsible for all services rendered.
Payments are due in full at the time services are rendered
· Co-Pays and Co-Insurance amount, deductibles, and all non-covered charges are the insured/patient’s financial responsibility and are due at the time services are rendered. Failure to produce payment could result in your appointment being rescheduled. You are expected to pay co-pays the day of service; We Do Not Bill you for Co-Pays
· Each visit will be a separate charge based on the on the reason for the visit. All insurance companies are billed in the exact manner; however; each insurance company has a different method of reimbursement.
· As a courtesy to our patients, we gladly accept cash, check, money order, Visa, Mastercard also Discover or American Express but there will be a service charge of 3%.
Copies Of Medical Records
· Requests are subject to $25.00 charge for the first 25 pages, fifty cents for each additional page, and $5.00 handling fee.
· Any paperwork completed by the Physician such as disability forms, special insurance forms, etc. will result in a $20.00 charge. Payment is due when you collect the completed forms/letters.
· Forms/Letters requires a 7 business day turnaround for completion.