Chiropractic is covered under many insurance plans. Most of our patients that have health or accident insurance will fall under one of the plans discussed in this policy. We ask that you read and understand our policy as it applies to your particular situation.

PATIENTS WITHOUT INSURANCE
We request that 100% of the first visit be paid at the time of the visit unless other arrangements have been pre-arranged and agreed upon. A payment plan can be established in writing.

GROUP OR INDIVIDUAL INSURANCE
When possible, we will call to verify benefits on your insurance. However, the benefits quoted to us by your insurance company are not a guarantee of payment. Payment will be due by you at the time of service for any non- covered services, deductibles or co-pays.

“ON THE JOB” INJURY (Worker’s Compensation)
If you are injured on the job, you will need to inform your employer of the accident and obtain the name and address of the carrier of their insurance. If your employer does not provide us with this information, if a settlement has not been made within three months, or if you suspend or terminate care, any fees and services are due by you immediately.

PERSONAL INJURY OR AUTOMOBILE ACCIDENTS
Please notify your auto insurance carrier of your visit to our office immediately. Notify our insurance department immediately if an attorney is representing you. Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to six months after your care is initiated. Once the claim is settled or if you suspend or terminate care, any fees for services are due by you immediately.

MEDICARE
We do accept assignment from Medicare. The check is usually sent directly to our office in payment of the services that Medicare will cover which for Chiropractors is ONLY manual manipulation of the spine. Medicare pays 80% of the allowable fee once the deductible has been met. You are required to pay the deductible and the remaining 20% as well as any non-covered services. Our office completes and files the forms for Medicare at no charge.

SECONDARY INSURANCE
Please inform us of any secondary insurance you may have. We will assist you if you need help in filing.

INSURANCE ONE TIME AUTHORIZATION
I understand that my insurance is an arrangement between myself and my insurance company, NOT between Absolute Health and my insurance company. I request that Absolute Health LLC prepare the customary forms at no charge so that I may obtain insurance benefits. I also understand that if my insurance does not respond within 60 days, or if I suspend or terminate my schedule of care as prescribed by Absolute Health, that fees will be due and payable immediately.

ASSIGNMENT OF BENEFITS
I authorize that any insurance benefits or reimbursement for services rendered which amounts would otherwise be payable to me under any insurance, pre-paid health care plan, or Medicare be made directly to: Absolute Health LLC

RELEASE OF INFORMATION
I authorize the release of any information concerning my health and health care services to my insurance companies, pre-paid health plan, or Medicare.

MISSED APPOINTMENTS
Due to our efforts to accommodate all patient when they need to be seen, we ask that if you are not able to keep your scheduled appointment, that you cancel no later than 24 hours in advance.  We understand that although circumstances at times may prevent your doing this, after a second missed appointment we may add a $25.00 missed appointment charge to your account.  A charge of $ 25.00 is for bounced checks. This is to cover the penalty the Bank is charging us for each bounced check.

PAYMENT AGREEMENT
I understand that there is no guarantee that my insurance companies, pre-paid health plan, or Medicare will cover or pay for all of my charges. Notwithstanding denial, reduction of benefits or failure to pay for any reason, I understand that I am responsible for all remaining charges.