Pease Integrative Medicine Office is committed to meeting our patient’s healthcare needs and keeping their insurance and other financial arrangements simple, secure, and efficient. In order to accomplish this in a cost effective manner we have set forth the following terms we expect adherence to by patients and staff members.

1. Patients will be assigned to a Family Account in accordance with the Practice Family Account Policy.

2. Patients must provide proper identification, current address, telephone number, email address and current insurance information upon request and at least every visit.

3. Patients must provide an individual Guarantor who must provide a secure method of payment to be kept on file in accordance with the Practice Family Account Policy. The secure method of payment will  be kept along with patient medical records and any payment method ID numbers will not be stored on site, nor within the EMR/PM system, nor be visible to Pease Integrative Medicine Office staff once the payment method has been captured. For security, Elation itself only displays the card type, last four digits, and expiration date for saved cards - never the full card number.

4. All copay amounts are due and payable at the time of service and are to be collected prior to the patient seeing a provider. Any and all outstanding balances are due, or written arrangements made and in place, prior to further services being rendered. Pease Integrative Medicine Office may elect to deny service (office visits, prescription refills, forms, etc.) for failure to pay copays at the time of service or outstanding balances upon demand and failure to provide guarantor information and payment method on file.

5. Pease Integrative Medicine Office will submit claims to a patient’s health insurance carrier for payment of services rendered and follow existing participation agreement procedures for filing of claims as long as there is an acceptable form of secure payment on file that will satisfy any amount left unpaid (most commonly due to co-insurance or deductible amounts) after the claim has been adjudicated or a maximum of 45 days from the date claims were filed. Any and all outstanding amounts will be recouped via the secure payment method on file.

6. Payments and adjustments to claims submitted to insurance carriers on behalf of patients will be applied to the charges for services rendered pursuant to any participation agreement (if exists) between Pease Integrative Medicine Office and the patient’s health insurance company. If no contractual agreement exists the full amount of the charges for services rendered will be due and payable.

7. Uninsured patients must sign the Guarantor Agreement and provide a secure payment method prior to services being rendered and the amount owed for services will be recouped from the secure payment method as soon as the actual charge amount has been determined (usually 2 – 5 business days after the visit or services rendered).

8. If the full amount of the fee for services is not satisfied by the secure method of payment on file a statement will be generated for any outstanding amounts owed. The statement may be mailed or communicated electronically to the account guarantor and is considered due upon receipt. Any time a statement is generated there will be a $5 statement fee charged to the account.

9. Pease Integrative Medicine Office will do its best to communicate with patients and guarantors through all means available (statements, email, telephone, in person) any outstanding balances and work to resolve those balances to mutually beneficial arrangements.

10. Any time an account has an outstanding balance that is left unpaid for more than 60 days from the date of service Pease Integrative Medicine Office may pursue all legal and credit action against the account guarantor and deny any and all further services to all patients on the account.

11. If a credit balance is found to exist on an account the practice will first apply the credit to the oldest outstanding charge on the account across all patients in the account. If all charges have been satisfied and a credit balance still exists then the practice will issue a refund to the appropriate person (the payee of the originating payment that resulted in a credit or the account guarantor) in the form of a check and mail it to the appropriate person or the guarantor address on file unless other arrangements are made by the original payee or the account guarantor.