Please do not accept the reduced discounted fee so you can to be seen now, unless you agree and recognize that we can file later to receive the legitimate funds to which we are entitled for the specific procedures we performed.  We can file only when and if the chiropractic deductible is met, unless you pay full price for services in advance on that service date.
The patients given a discounted fee are restricted.  You can wait until patients drop off, discontinue their plan of care, or whenever space is available for us to call you to participate.
 All receipts for any services filed with BCBS are balanced to express BCBS's remittance.  Both of us receive the same remittance, so you always should know the dispensation.


BCBS determines the amount owed by the patient and any monies from the filed procedures toward a deductible and the coinsurance and/or copayment.  They also determine what the provider is to receive.  We do not!

No doctor anywhere will file insurance after only receiving a discounted fee, coupon, or some exchange of services.  They only file with an expectation and a signed agreement that either/or your carrier and you together must satisfy the full retail cost of the entire services filed.

No provider keeps more money than what is reconciled by the remittance.  Credits can occur only when you have paid a discounted initial fee that exceeds a later to be determined coinsurance and/or co-payment.  Balances are owed when insurance did not pay us, and "Patient Owes Amount" is greater than what you paid that day of service.

We always estimate coinsurance on the day of services. We have been estimating low, and accepting only this low amount as long as it's close.  However, in applying any credit, we look at the actual "Patient Owes Amount" to determine any credit.



Higher deductibles have led to special saving/checking accounts to be used for this deductible; however, we do not receive funds on the day of service.  Often they are not forthcoming.  BCBS calls these HRS/HSA funds that "might be available." You must use these funds to pay for the full retail costs that will be filed with the carrier.  You cannot use these funds for a discounted fee.

You will never meet these higher deductibles using exclusively chiropractic services, either discounted or retail.  It's far less funds to pay upfront the discounted fees as you go.  If you insist, we will hold you personalty responsible to the full retail costs  We will not let these retail costs accrue with follow up visits.  We will not pay down a deductible unless we receive full compensation before we proceed.
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CHIROPRACTIC FEE


REDUCED MINIMAL FEE            FOR HELPING YOU TODAY            office procedure 2018

We only take BCBS insurance as an in-network Preferred Provider.

IF YOUR CHIROPRACTIC DEDUCTIBLE IS NOT MET, INSURANCE WILL NOT PAY US FOR THE CLAIM UNTIL THIS DEDUCTIBLE HAS BEEN MET. THIS MUST BE CONFIRMED BY US AFTER VIEWING THE BCBS WEBSITE.  OFTEN THIS IS NOT EASILY ACCESSIBLE OR RELIABLE.

IND CHIRO DED REMAINING______________ FAM CHIRO DED REMAINING_____________

You are obligated to either a minimal reduced amount $100 1ST fee with a $50 DISCOUNTED FOLLOW UP FEES. These discounted fees for regular chiropractic treatment visitations can be given only with the understanding that no insurance is filed. These discounted fees will/cannot be filed until your insurance is active for the procedures received, or a higher upfront $150 1ST fee with $100.00 follow up fees are required to be filed with your inactive insurance in an attempt to CONTRIBUTE AN EQUAL AMOUNT FOR THE SERVICES RECEIVED TO CONTRIBUTE TO YOUR DEDUCTIBLE, IMMEDIATELY IF YOU CHOOSE.

If you are a new patient, you will likely be required to have x-rays and pay their cost up to $100-$310.00 depending on the necessary current x-rays required by the doctor (not MRI), only for the first visit OR EARLY IN THE TREATMENT PLAN. Otherwise, when you pay for treatment, you will pay at least the discounted fees with no insurance filed at this time or the full retail billing fees if you want your insurance claim filed immediately; no other amount will be owed this office BY YOU for your chiropractic services. When you have exhausted your insurance, you will be seen for the minimal discounted fee but these additional visits need not be necessarily filed as a claim. UNLESS YOU PAY AT LEAST $100.00 PER TREATMENT SESSION, WE WILL NOT FILE A CLAIM AND ACCEPT ASSIGNMENT UNTIL THE DEDUCTIBLE HAS BEEN MET.

*AS A CONDITION FOR BEING ABLE TO PROVIDE DISCOUNTED FEES, ANY PAST CLAIMS WILL BE FILED TO RECUPERATE ANY LEGIBLE FUNDS TO OUR ADVANTAGE WHERE YOU MAY RECOVER THE DIFFERENCE BETWEEN WHAT YOU PAID AND THE COPAY/COINSURANCE LESS ANY SMALL CONTRIBUTION WE MAY HAVE MADE TO THE DEDUCTIBLE.

PLEASE DO NOT ACCEPT THIS DISCOUNTED FEE IF YOU BELIEVE IT TO BE A COMPLETE FEE FOR ALL THE PROCEDURES PERFORMED FOR ANY INSURANCE PURPOSE.

CHECK OPTION BELOW           OPTIONS FOR PAYMENT OF TX

_____$100 1ST/50.00 VISIT WITH NO FORMAL CLAIM AT THIS TIME/ WILL NOT ACCEPT ASSIGNMENT (NO)

_____$150 1ST/100.00 VISIT/NONACTIVE INS/CLAIMED IMMEDIATELY FILED/ ACCEPT ASSIGNMENT (YES)

_____COPAY/COINSURANCE ESTIMATE WHEN ACTIVE INSURANCE (DEDUCTIBLE MET FOR YEAR OF SERVICE)/ ACCEPT ASSIGNMENT (YES)

_____ANY POSSIBLE CASE INVOLVING AUTO, WORKMAN COMP, DISABILITY, YOUR PERSONALLY FILING INSURANCE FOR RECOVERY, OR ANY SITUATION WHERE WE COULD BE ASKED TO FORMALLY FILE AND PROVIDE INFORMATION. THESE WILL BE DECLINED.

   WE DENY ALL AUTO CLAIMS, SO IT IN YOUR BEST INTERESTS TO SEEK HELP ELSEWHERE.

OUR ACTIONS ARE DETERMINED BY WHAT YOU PAY at the time of service. *CLAIMS WITH HEALTH OR AUTO INSURANCE CAN/WILL ONLY BE FILED BY THE SPECIFIC PROCEDURE AND DIAGNOSIS CODES AT THE PUBLISHED RETAIL FEES CONSISTENT WITH ALL INSURANCE CLAIMS FROM THIS OFFICE.

We are NOT FILING to contribute toward your deductible any amount greater than what we received or the recovery of funds unless you meet the conditions required for us to accept assignment AND RECOGNIZE THAT SOME CONVERSION MUST BE DONE WITH A
BALANCE OWED BY YOU IF WE ARE ASKED NOW TO ACCEPT ASSIGNMENT (REQUEST OF BILLING AND NOTES) WITH ANY LATER TO BE DISCOVERED AUTO CASE TO WHICH WE WERE NOT MADE AWARE AND WE INITIALLY NEVER ACCEPTED ASSIGNMENT.

We receive funds for the procedures only when the deductible has been met, so * it is possible that we may receive our expected claim's fees partially or in full at a later date; this must be understood as conditional or we cannot offer an initial reduced fee prior to the deductible being met. Now most contracts never pay out to the provider; all other insurance was found to take months to clear financially, if at all; few contracts have small enough deductibles that we can be paid the BCBS portion later for the legible year FOR THE ACTUAL PROCEDURAL AND DIAGNOSTIC CODES PERFORMED. It is not likely but it is possible based on all conditions that we will be justifiably paid by the insurer additional funds from the discounted fees , but if you paid as agreed on the date of service, you will not be expected to pay any more or any less than what is stated on the remittances.

You will pay a coinsurance or co-payment, or both, only when your insurance has been confirmed as active (WE "ACCEPT ASSIGNMENT"). All co-payment/coinsurance are prescribed and must be paid per visit.

We are NOT required to file a claim on inactive insurance ( deductible still applies) unless you require it to be filed promptly and are willing to immediately pay for all procedures performed by the doctor on that visit day (minimum $150-$100.00). Remember, we can only know for sure the insurer's dispensation of any claim after receipt of the remittance. We will track your deductible's status.

75% of all patients we do not accept assignment because of their chiropractic insurance status so they CHOOSE to join the few on the discounted fee program for the year. 20-25% have immediate active BCBS coverage for which we are primarily established.

30% of all inactive BCBS patients, we do eventually accept assignment to receive our insurance portion. * Any money received from a carrier is applied to your account by date received and for only the date of service FROM WHICH YOU WILL BE CREDITED THE DIFFERENCE BETWEEN THE DISCOUNTED FEE AND THE REQUIRED COPAY/COINSURANCE LESS ANY FUNDS PAID BY US TOWARD THE DEDUCTIBLE BUT ONLY WHEN WE ARE PAID THE FULL BCBS REDUCED FEES FOR ALL PROCEDURES FILED ON THAT VISIT.

Billing accounts are an ever changing and on-going process, therefore they cannot on demand be a reflection of funds with a final reconciled balance at the time of viewing. When closed or with reasonable notice, these accounts can/will be balanced by the Case Manager.

I UNDERSTAND AND CONFIRM

X_______________________________________________________DATE_____________