Payment & Insurance
I authorize Alivation Health, L.L.C. to release to the Insurance carrier(s) provided any medical information needed for authorization or payment of this or a related claim. I also authorize payments directly to this office for the health benefits. I understand that I am responsible for all pre-authorizations required by my insurance. Furthermore, I understand that I am financially responsible for all charges.
For the benefit of our patients, Alivation Health is contracted with most insurance companies. We accept cash, checks and credit cards (Visa, Discover, and MasterCard). Some services we offer, such as school physicals and weight management services, may not be covered by insurance. Insurance coverage varies based on each patient's individual insurance plan.
Monthly Billing Statements: Every month our office sends out a monthly billing statement to every patient. The balance due is the remainder owed after your insurance has paid.
Copayments: Copays are due at the time of service, if you are unable to pay at the time of service you may need to reschedule your visit. If your visit will not take place in the clinic you may be asked to pay your Copay at time of scheduling.
Insurance Cards: Insurance cards are required at every visit. If you have not provided our office with the correct insurance information, you will be responsible for any balance due.
Self-Pay Patients: If you do not have insurance, your balance is due at the time of your office visit. If you are unable to pay at time of service, you may be asked to reschedule.
Payment Plans: If you have negotiated a payment plan with us, you are responsible for making timely and consistent monthly payment s. If you fail to make your scheduled due date, your account will be sent to collections for nonpayment.
Screening Labs: If a screening lab is done, some of the charges from the lab may be applied to your deductible. Please speak with the provider if you would like a limited lab draw instead of the recommended full screening lab.
Late Arrival: If you arrive more than 15 minutes late, we may need to no-show your appointment & reschedule or we may ask that you wait until the next open spot in the schedule while we continue to see the patients who arrived on time.
No-Show Fees: I have been advised that this office requires a 24-hour prior notice on all appointment cancellations. I have been advised that there will be a no-show fee for appointments that are canceled with less than 24-hours' notice. This fee is not covered by any insurance plan. Fee varies based on appointment type missed and are updated from time to time.
Collections: If your account balance is unpaid and overdue after three attempts to contact you, and you have not responded to any of our attempts to contact you, your account will be referred to a collection agency. Once your account is in collections, you will be dismissed from our practice, which includes refill requests and appointments.
Pre-Authorization for Mental Health Services: Most insurance companies require pre-authorization for mental health services, prescription medications, and certain medical treatments. We strongly encourage you to contact your insurance to inquire about any pre-authorization requirements. You may also want to obtain information regarding your health benefits. Most often, health insurance benefits for mental health are different from the benefits for general healthcare. Please contact our billing office should you have any questions regarding the information from your insurance.