The following is the summary of our payment policies and what we expect from all our patients.
Payments:
All payment is expected at time services are rendered unless other arrangements have been made in advance. This includes but is not limited to applicable coinsurance, copayments, and deductibles for participating insurance companies. Block Chiropractic and Rehabilitation Center, LLC accepts cash, personal checks, Visa, Mastercard, and Discover. There is a $25 service charge plus the bank fee for returned checks.
Patients with an outstanding balance 60 days or more overdue must make arrangements for payment prior to scheduling appointments. We realize that certain patients do experience financial hardships. In such circumstances the patient or patient's representative may request a financial consultation with the office manager to discuss other arrangements. Any action taken in response to any request is at the sole discretion of Block Chiropractic and Rehabilitation Center, LLC.
Insurance:
Block Chiropractic and Rehabilitation Center, LLC bills participating insurance companies as a courtesy to the patient. The patient is expected to pay all deductibles, copayments, and coinsurance at the time of service. We will also verify insurance benefits as a courtesy to the patient, however, it is the patient's responsibility to understand his/her policy's benefits.
We will also bill secondary insurance companies as a courtesy to the patient. Again, it is the patient's responsibility to communicate with his/her primary insurance company for any bills to be forwarded to the secondary insurance company.
HMOs:
If the patient's insurance policy is an HMO and the patient is in need of a referral prior to his/her visit, it is the patient's responsibility to obtain that referral prior to coming to the first visit at Block Chiropractic and Rehabilitation Center, LLC.
Missed appointments:
Missed appointments represent a cost to Block Chiropractic and Rehabilitation Center, LLC and to other patients who could have been seen during the time set aside for the appointment. Cancellations are required at least 24 hours prior to the appointment. Block Chiropractic and Rehabilitation Center, LLC reserves the right to charge for missed or late-canceled appointments. Block Chiropractic and Rehabilitation Center's fee for a missed appointment without adequate notice is $70. Excessive abuse of scheduled appointments may result in discharge from the practice.
Credit Card on File policy:
At Block Chiropractic and Rehabilitation Center, LLC we require all patients to keep a credit card or debit card on file as a method of payment for the portion of services that insurance does not cover but for which the patient is liable. The credit card will also be charged for any missed appointments without 24 hours prior notice of cancellation and for any unpaid non-insurance services.
All patients' credit card information will be kept confidential and secured. The credit card will only be charged after the insurance claim has been filed and processed by the patients' health insurance company. Block Chiropractic and Rehabilitation Center, LLC will bill the patient prior to charging the card. Any bill that is left unpaid for 30 days will be charged to the credit/debit card on file; however, Block Chiropractic and Rehabilitation Center, LLC will first contact the patient to advise of the upcoming transaction.
I authorize Block Chiropractic and Rehabilitation Center, LLC to charge the portion of my bill that is my financial responsibility to my credit or debit card as per the above policy.
I, the undersigned, authorize Block Chiropractic and Rehabilitation Center, LLC to charge my credit or debit card for any balance due for services rendered that my insurance company identifies as my financial responsibility or non-insurance services that remain unpaid after 30 days. This authorization will remain in effect until I cancel this authorization. To cancel, I must give a 30 day notification to Block Chiropractic and Rehabilitation Center, LLC in writing and the account must be in good standing.