***PLEASE CHECK IF APPOINTMENT DATE/TIME IS AVAILABLE BEFORE FILLING OUT ALL YOUR INFORMATION***
INSURANCE BILLING NOTIFICATION:
If your insurance plan changes please notify us right away so that we can update your information and bill your insurance in a timely manner. If any claims are denied due to insurance updates or gaps you will be still be responsible for any unpaid treatments or denied claims.
PPO Plans: We accept most PPO insurances and bill your insurance as an out of network provider. Please email us the back and front of your insurance card at healingwithneedles8@gmail.com so that we can check to see if acupuncture is covered under your plan.
HMO Plans: If you have an HMO plan please contact us directly at (916) 426-6991 or email us the front and back of your insurance card at healingwithneedles8@gmail.com and we can check to see if we are contracted with your insurance plan and if acupuncture is covered.
VETERANS: We accept Tri-West, but you must contact your representative at Tri-West to get prior approval first prior to scheduling your first appointment.
WORK COMP: We work with a few workman compensation groups, please have your representative or case work call us prior to scheduling any appointments to ensure that we are contracted with them.
Under insured/Medi-Cal/Medicare: please contact us at (916) 426-6991 or healingwithneedles8@gmail.com
Please read the information below carefully and understand the terms.
ASSIGNMENT OF INSURANCE BENEFITS AGREEMENT
Our office will accept an assignment of benefits from your insurance company with the following provisions. It is important to understand, though, that the contract regarding your acupuncture benefits is between you, your employer,
and your insurance company. The obligation you have with our practice is to pay for treatment, regardless of the amount that may or may not be reimbursed by your insurance company. The following provisions identify our policies governing insurance claims:
❖ Although we are willing to complete insurance information forms and submit a claim on your behalf, we do not accept responsibility for the outcome of the transaction. Completing insurance forms is a courtesy we extend to you in an effort to maximize your insurance reimbursement. By having our office process your insurance forms, it is important that you understand that this does not eliminate your financial obligation for your treatment.
❖ We require you to sign this form and/or any other necessary assignment documents that may be required by your insurance company. This instructs your insurance company to make payment directly to our office.
❖ We require you to pay the co-payment/coinsurance, which is the amount not covered by your insurance company, at the time
we provide service to you.
❖ Insurance payments ordinarily are received within 30-60 days from the time of billing. If your insurance company has not made payment to our office within 60 days, we will ask you to pay the balance due at that time. You will be
responsible for seeking reimbursement from your insurance company at that time.
❖ Our office does not guarantee that your insurance company will pay for treatment you receive from our practice. We perform routine insurance billing procedures upon verification of coverage. However, if your claim is denied,
you will be responsible for paying the full amount at that time.
❖ Our office will not enter into a dispute with your insurance company over any claim, although we will provide necessary documentation your insurance company requests to sort out any confusion or questions that may arise.
We will cooperate fully with the regulations and requests of your insurance company. It is ultimately your responsibility to resolve any type of dispute over payments made or not made by your insurance company.
