Chiropractic care is covered under many insurance plans. Most of our patients that have health or accident insurance will fall under one of the plans discussed in this policy. We ask that you read and understand our policy as it applies to your particular situation.

1. Patients Without Insurance

We request that 100% of the first visit be paid at the time of the visit. On other visits payment may be made at the end of the week. Your account must be at a zero balance at the end of each week. We are happy to accept cash, your check, Master Card, Visa, Discover and American Express.

You will call to verify benefits on your insurance. Call your insurance company and complete a Health Insurance Questionnaire form. This must be returned to our office by your second visit. Payment will be due by you at the time of service. We will give you an invoice for each visit that has all the information for your insurance company to reimburse you, depending on your type of coverage.

3. “On the Job” Injury (Worker’s Compensation)

If you are injured on the job, your care should be paid for under your employer’s Worker’s Compensation insurance. You will need to inform your employer of the accident and have approval prior to being treated in this office. You must also obtain the name and address of the carrier of the employers insurance and you must have your employer sign a release to be treated that you receive from your employer. If you suspend or terminate care, any fees and services are due immediately.

4. Medicare

We do not accept assignment from Medicare. The check is usually sent directly to you in payment of the services that Medicare will cover which for Chiropractors is ONLY manual manipulation of the spine. Medicare does NOT cover X-rays, exams, therapy or nutritional supplements. Medicare pays 80% of the allowable fee once the deductible has been met.

5. Medicaid or Title 19

We do accept assignment for Medicaid and Title 19. However the exam and x-rays required are not covered under that insurance. We are required to perform an exam and in some circumstances request that x-rays be made. Exams must be paid for at the time of the visit. X-rays payment is done through Medicaid or Title 19 through the x-ray facility. (Either Towncrest X-ray or Mercy Hospital)

Payment of one dollar is due at each visit.

6. Personal Injury or Auto Accident

Please notify your auto insurance carrier of your visit to our office immediately and complete our Health Insurance Chiropractic Questionnaire. This form must be turned in to our office by the 2^nd visit. We do not file to “at fault” payers. You may pay at the time of service and submit to “at fault” payer. Notify our office if an attorney is representing you. Although you are ultimately responsible for your bill, we will wait for settlement of your claim for up to 6 months after your care is completed if an attorney is involved and your Med Pay is exhausted. You will sign a lien for the payment from the settlement. Once the claim is settled or if you suspend or terminate care, any fees for services are due immediately.

7. Secondary Insurance

Please inform us of any secondary insurance you may have. This helps us assist you in receiving prompt reimbursement.

8. Managed Care

We are not on any preferred provider list but we encourage you to submit your claims to the insurance company to keep them informed of what their clients choose to do and to use up your deductible if it will apply.

I have read and understand the payment policy of Quantum Healing Chiropractic (QHC). I understand that my insurance is an arrangement between myself and my insurance company, NOT between QHC and my insurance company. I request that QHC prepare the customary forms at no charge so that I may obtain insurance benefits. I also understand that if I suspend or terminate my schedule of care as prescribed by the doctor at QHC that fees will be due and payable immediately.

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