Monthly Statement: If you have a balance on your account, we will send you a monthly statement. It will show separately each visit you were seen for, the payments made by your insurance company to those dates, any contract adjustments; other adjustments if applicable, co-pays and other payments you have paid, and finance charge, if any. For any balance paid the previous billing cycle, these visits will not appear on future statements.
Payment if you have no insurance: Full payment is due at the time of service; Initial Physical Therapy evaluation with treatment $180.00; all following visits $140.00. Massage Therapy: $100.00 per visit and Acupuncture $100.00 per visit.
Payment if you have insurance: We will bill your insurance if we are providers with them. Please check with us or your insurance company to see if we are providers. Not all our providers are contracted with the same insurance companies. You are responsible for all charges not paid by your insurance company.
Payments: Unless other arrangements are approved by us, the balance on your statement is due and payable when the statement is issued, and is past due if not paid by the 25th of each month.
Charges to Account: We shall have the right to cancel your privilege to make charges against your account at any time. Future visits would then need to be paid at the time of service.
Contracted Insurances: If we are contracted with your insurance company, we must follow our contract and their requirements. If you have a co-pay or deductible, you must pay that at the time of service. It is the insurance company that makes the final determination of your eligibility. If your insurance company requires a referral and/or preauthorization, you are responsible for obtaining it. Failure to obtain the referral and/or preauthorization may result in a lower payment or denial of payment from the insurance company. You are responsible for all charges not paid by your insurance company.
Non-contracted Insurances: Insurance is a contract between you and your insurance company. We are NOT a party to this contract. We will bill your primary insurance company as a courtesy to you. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility. You are responsible to pay any portion of the charges not covered by insurance. If your insurance company requires a referral and/or preauthorization, you are responsible for obtaining it. Failure to obtain the referral and/or preauthorization may result in a lower payment from the insurance company.
Finance Charge: A finance charge will be imposed on each item of your account which has not been paid within thirty (30) days of the time the item was added to the account. The FINANCE CHARGE will be computed at the rate of 0.75 percent (0.75%) per month (ANNUAL PERCENTAGE RATE of nine (9%) percent), or $5.00 per month, whichever is larger. The finance charge on your account is computed by applying the periodic rate to the overdue balance of your account. The overdue balance of your account is calculated by taking the balance owed thirty (30) days ago, and then subtracting any payments or credits applied to the account during that time.
Required payments: Any co-payments required by an insurance company must be paid at the time of service. Because this is an insurance requirement, we must receive co-pays at the beginning of your visit. Unpaid co-pays will result in a $10.00 billing fee added to your monthly statement. To assist our patients with high annual deductibles, we offer our patients the ability to make minimum $50 payments towards their deductibles at the time of service. We will then bill the remaining amount on the monthly statement.
Returned checks: There is a fee (currently $50) for any checks returned by the bank.
Past due accounts: If your account becomes past due, we will take necessary steps to collect this debt. If we have to refer your account to a collection agency, you agree to pay all of the collection costs which are incurred. If we have to refer collection of the balance to a lawyer, you agree to pay all lawyers’ fees which we incur plus all court costs. In case of suit, you agree the venue shall be in King County, Washington.
Waiver of confidentiality: You understand if this account is submitted to an attorney or collection agency, if we have to litigate in court, or if your past due status is reported to a credit reporting agency, the fact that you received treatment at our office may become a matter of public record.
Divorce: In case of divorce or separation, the party responsible for the account prior to the divorce or separation remains responsible for the account. After a divorce or separation, the parent authorizing treatment for a child will be the parent responsible for those subsequent charges. If the divorce decree requires the other parent to pay all or part of the treatment costs, it is the authorizing parent’s responsibility to collect from the other parent.
Transferring of Records: You will need to request in writing, and pay a reasonable copying fee if you want to have copies of your records sent to another doctor or organization. The amount of the fee is dependent on the number of pages we need to copy. You authorize us to include all relevant information, including your payment history. If you are requesting your records to be transferred from another doctor or organization to us, you authorize us to receive all relevant information, including your payment history.
Workers Compensation: We require written approval/authorization by your employer and/or worker’s compensation carrier prior to your initial visit. If your claim is denied, you will be responsible for payment in full.
Personal Injury: If you are being treated as part of a personal injury lawsuit or claim. We require that you allow us to bill your health insurance. In the absence of insurance, you will be charged the cash rate, which is due at the time of service. Payment of the bill remains the patient’s responsibility.
Missed Appointments and Late Cancellations: Our therapists value your time and request that you value theirs. The first two appointments not kept, cancelled, and/or rescheduled at least 24 hours prior to the scheduled appointment time will be charged $50.00 each. The third and all subsequent appointments not kept, cancelled, and/or rescheduled at least 24 hours prior to the scheduled appointment time will be charged $100.00 each. These charges cannot be billed to your insurance company and will be your responsibility. Missed appointment fees must be paid at the next scheduled appointment.