MCC Financial Policy
Restoring your health is our foremost objective. Our treatment will always be rendered solely on the base of need. We require payment at the time of service unless special arrangements have been previously made. Our fees comply with the "usual and customary" rates for this region. We accept cash, checks, Visa and MasterCard. For patients who are unable to pay at the time of service, special arrangements are available upon request. Financial assistance is available to those who qualify. If you feel you have a financial hardship and can not pay for your care, please contact our receptionist or billing service (CompuMed Medical Billing Specialists, LLC) for an application to see if you qualify for financial assistance.
REGARDING ALL INSURANCE We cannot promise that an insurance company will pay for your care, even when it is preauthorized. As a courtesy to you, we will submit bills to your insurance carrier, but will not become involved in disputes between the insured and the insurance carrier. This courtesy will commence as soon as we are able to confirm coverage for chiropractic services and have the proper, signed insurance forms. A copy of your drivers license or photo identification along with a copy of your current insurance card must be kept on file. We strongly urge you to contact your insurance company to verify your benefits; sometimes incorrect information is provided to us. See our "Patient's Guide to Insurance Verification" in the Forms section of our website. Payment of non-covered services and co-payments is expected at the time of service. As participating providers with most insurance plans your copay is expected at the time of service. We must report failure to pay your copay to your insurance carrier. Payment of non-covered services such as nutritional supplements, Biofreeze, cervical pillows and exercise equipment is expected at the time of purchase.
If an insurance company fails to pay for services within ninety days, the undersigned is responsible for payment. Ultimately, you are responsible for all outstanding balances. If the insurance company erroneously pays directly to the insured, the amount shall be forwarded to this office within three days.
X-ray over-read is performed by a chiropractic radiologist, Dr. Edward Dailey, DC, DACBR, of Professional Imaging Consultants. If you had x-rays taken in our office you may receive a statement from his billing department regarding his services.
MEDICARE: Medicare pays for only a portion of chiropractic services and limits the number of reimbursable treatments. Reimbursable care is limited to spinal manipulation and does not include other therapies, services and goods that may be necessary during care. Please be advised of the following Medicare restrictions and regulations.
- Medicare will pay for a maximum number of treatments per calendar year, based on your diagnosis. When the maximum number of treatments has been rendered, payment is expected at the time of service.
- Medicare will not pay for the physical examination or any necessary X-rays. This fee is the patient's responsibility and will not apply to the patient's deductible. Medicare patients should review the "Important Information for our Medicare Patients" in the Forms section of our website.
PERSONAL INJURY, WORKER'S COMPENSATION AND/OR LITIGATION: If your complaint is the result of an occupational or automobile accident, or if litigation is pending, please notify us. If an attorney is involved, patients are required to sign a Physician's Lien that will be forwarded to the attorney for signature. If we do not receive the signed lien from the attorney within fourteen days, all services must be paid for by the patient at the time rendered. It is our policy to bill the insurance company directly and will provide the attorney with a monthly statement.
Instances will arise when we exhaust all reasonable efforts to secure payment from your insurance company, but the insurance company refuses payment. We will do our best to assist you in securing payment, but all balances are ultimately your responsibility.
- Please notify us of any change to your insurance coverage, employer, home phone number and address. This will insure your claims are processed without delay.
- Patients who routinely do not show for appointments (3 consecutive no shows) may be charged a $30 fee per our financial policy.
- There will be a $35 return check charge applied to your account for any check presented for payment which is returned by the bank for any reason.
- A late fee charge of $25 will be applied to your account if payment is not received within 60 days.
If you have any questions or would like more information regarding our billing policies, your statement or account, please contact our billing service, CompuMed Medical Billing Specialists, LLC at 1-440-933-4400.
This notice is effective as of 08/15/2016.