Financial Policy
Thank you for choosing Integrity Wellness Center. Our goal is to provide you with the highest quality care possible.
We find that communication with our patients regarding our financial policy assists us in providing the best service to you.
Therefore, we take this opportunity to answer some of the most commonly asked questions. Please read it, ask us any
questions you may have, and sign in the space provided. A copy will be provided to you upon request.
Payment Method
Payment is expected at the time services are rendered. We accept a variety of payment methods, including cash, check, money order,
or credit card Visa, MasterCard, Discover and AMEX Credit card payments are also accepted via telephone.
Insurance Information
We must emphasize that your health is our primary concern, regardless of your insurance. Because your insurance policy is a contract
between you and your insurance company, please check with your insurance carrier to determine any pre-existing limitation or other benefit
restrictions that you may have, prior to your appointment. We will file your insurance as a courtesy and assist you in any way we reasonably
can to help get your claims paid. Your insurance company may need you to supply certain information directly.
It is your responsibility to comply with their request. Please be aware that any unpaid balance of your claim is your responsibility,
whether or not your insurance company covers your claim.
Most insurance companies do not cover 100% of the cost of services, and there is a portion that the patient is responsible for.
There are several patient responsibility components that may apply to an insurance payment.
Co-pay – A set dollar amount per office visit that is the patient’s responsibility.
Co-insurance – A percentage of the charge that is the patient’s responsibility.
Deductible – A set annual amount that the patient is responsible for paying prior to his or her insurance making a payment.
Because of the contract you have with your insurance company, we are obligated to collect payment from you for your portion of the balance.
All co-payments, co-insurance and deductibles must be paid at the time of service. This arrangement is also part of your contract with your insurance company.
To bill your insurance accurately and in a timely manner, we will need assistance from you.
We ask that you provide our office with accurate demographic information (address, phone number, etc.) and proof of insurance.
All patients will be required to show proof of insurance and a government issued photo ID.
Insurance Changes
If there are any changes in your insurance, you are required to call our office and give the detailed changes of your insurance at least
twenty-four (24) hours prior to your appointment.If you fail to provide us with the correct insurance information in a timely manner,
you may be responsible for the balance.
Managed Care: All managed care (i.e. HMO, PPO, and POS)
Co-payment, co-insurance & deductible amounts are due at the time of check-in. If your insurance plan requires a referral authorization
from a primary care physician you are responsible for obtaining prior approval from your PCP prior to treatment & will need to present this
at your visit. If you request an office visit or procedure without a referral authorization, your insurance plan may deem this as non-covered
treatment and you will be responsible for the charges.
Secondary & Tertiary Plans
We will bill your secondary insurance as a courtesy. We do not bill tertiary insurance. If you have supplemental insurance to cover the portion
of the charges that Medicare or your primary insurance carrier does not pay, please provide us with a copy of this insurance card.
Medicare and secondary carriers do not cover some procedures and supplies.
Please make certain you understand which aspects of your treatment are covered before proceeding.
Preauthorization
Although we will assist in any way possible, please remember that it is ultimately up to you to understand the requirements of
your individual insurance plan, and know whether prior authorization from your insurance company is required
Non-covered Services
Any care not paid for by your existing insurance coverage will require payment in full at the time services are provided
or upon notice of insurance claim denial.
Auto Injury Cases
This office does NOT bill auto insurance for auto accident cases. We do NOT accept liens or letters of protection (LOP’s).
Worker’s Compensation
If your injury is work-related, we will need the claim number, date of injury, employer, and worker’s compensation carrier prior
to your visit in order to bill the worker’s compensation insurance company.
Cash Patients
Cash patients are accepted on a case by case basis. All uninsured patients will be required to pay in full at time of treatment.
Surgery & Injection Fees
All co-pays, co-insurance, deductibles, and payments for non-covered surgical procedures are due prior to surgery.
We will make every attempt to determine your coinsurance amount prior to your surgery. This will be based on your
insurance benefits and an estimate of the services to be provided. We will provide you with that estimate & we will
expect to collect that amount prior to the time of surgery. If any changes are made to the scope of services provided
and the coinsurance amount has changed, we will either refund or bill you upon final resolution of your account.
Fees are ultimately the responsibility of the patient, whether your insurance company pays or not, and are due
within thirty days of your receipt of Integrity Wellness Solutions statement.
Nonpayment
Please be aware that patient accounts over 180 days without satisfactory payment will be turned over to a
collection agency and patients will face possible termination from the practice.
Returned checks
A $25.00 fee will be charged for any returned checks and we will report bad checks to the District Attorney’s Office.
We will be unable to accept your check for any services thereafter.
Missed appointments
A scheduled appointment is a commitment of time between you and our practice, a time we have reserved just for you.
If you are unable to keep a scheduled appointment, please cancel or reschedule your appointment at least 24 hours in
advance to avoid a service charge and help us meet the needs of other patients. Patients who habitually fail to keep
scheduled appointments and do not give a 24 hour cancellation notice will face treatment termination.
Children of Divorced Parents
Responsibilities for payment of patients, who are minor children, whose parents are divorced,
rest with the parent who seeks the treatment.
Medical Records
Please direct all medical record requests or questions to your physicians’ business office.
Charges for Forms
A $30.00 fee will be charged for disability, life insurance, and
other forms requested by a third party or patient.
Special Circumstances
We are aware that circumstances in our daily lives may vary. If you need to establish a payment plan or require additional assistance,
please contact our Business Office prior to your scheduled appointment. Unless you have made prior arrangements for payment of
your balance, our financial policy will stand.
Account Billing Questions & Refunds
Questions or concerns regarding your account or insurance claim should be directed to our business office staff. If your account has a
credit balance, we will promptly release a refund check to you once your insurance carrier has processed all pending insurance claims
remaining on your account. If you feel an error appears on the statement or if you have any questions or concerns please contact our
billing office immediately at
(469) 307-5110.