Financial Policy

THIS Financial Policy (this “Policy”) is made effective for all purposes and in all respects by and between INTEGRATIVE BEHAVIORAL HEALTH & MEDICINE, INC. (hereinafter the “IBHM”) and the patient (hereinafter the “patient”) receiving care at IBHM as of the date patient receives care for the first time through IBHM.

Insurance and out-of-pocket Policies

The providers at IBHM are currently contracted or in the process of getting contracted with various insurance companies. In-Network participation by IBHM and its providers with various providers may change without notice, however, we will try our best to inform the patient if such changes occur. If the provider you plan to see accepts your insurance plan, we will bill based on your insurance coverage. If the provider doesn’t take your insurance plan, you have the option to see the provider and pay out-of-pocket. The financial policy governing each option is as follows:

Insurance

This section applies if the provider you are seeing accepts your insurance, and the patient wants to use their insurance coverage for their treatment.

PLAN COVERAGE: Every insurance plan is different in terms of benefits and financial obligations. The insurance plan may not cover all the services or the mode in which services are provided (e.g. Telehealth, therapy, alternative medicine, treatments, etc.). It is the patient’s responsibility to check with their insurance company to determine if the service they seek is covered by their insurance plan. The patient should check relevant sections of the insurance coverage booklet or check with their insurance plan administrator. The team at IBHM will provide the patient with assistance in receiving the benefits to which they are entitled, however, the patient is responsible for full payment of their bill if the insurance declines the payment for any reason.

Telehealth Services

The patient must check if telehealth visits are covered by their insurance plan, before engaging with IBHM for telehealth services.

After IBHM has the information about the patient’s insurance coverage, the patient’s provider will discuss what the provider can accomplish with the available benefits, and what options the patient may have if the benefits run out before the patient feels they are ready to end their treatment. The patient may pay out of pocket to avoid issues with their insurance company unless it is prohibited by the patient’s insurance contract.

ADDITIONAL PROFESSIONAL SERVICES: IBHM charges on a prorated basis for additional professional services and paperwork such as disability paperwork, detailed treatment summary & report writing, extended phone consultations, etc. The team at IBHM will inform you of such additional charges in advance, based on the out-of-pocket fees.

PAYMENTS: It is the patient’s responsibility to pay any co-payments as required by the insurance policy and for any charges not covered by their insurance plan. The patient is also responsible for full payment of their bill if their insurance company declines the payment for any reason. Please see the out-of-pocket section for details.

IMPORTANT: The patient should let our office know if there are any changes to their insurance plan or coverage immediately. Failure to do so may result in the patient’s claim being denied by the insurance and the patient may have to pay based on our out of pocket rates.

Out-of-pocket:

If we don’t accept the patient’s insurance plan, the service is not covered by the insurance plan or the patient wants to pay out-of-pocket for the services, the following rates will be applicable based on the provider type and encounter type.

* IBHM may be able to offer discounted rates for cash/out of pocket-only patients based on their situation and if the patient can provide proof of financial need. Please contact our office for discounted rates.

The patient’s insurance plan may have out-of-network coverage, which may partially cover our fees. Patients are advised to contact their plan administrator for details on their out-of-network coverage. A bill for services rendered and paid for will be provided to the patient at their request.

Confidentiality of Patient Information

The patient should be aware that the insurance company requires the clinical diagnosis and information about the services provided to the patient to process any insurance claims. Sometimes the insurance companies need additional clinical information like the treatment plan, treatment summary, copy of the patient’s clinical record, etc. In such situations, IBHM will provide them with only the necessary information needed for the processing of the insurance claim or only the records requested by the insurance. Please note that IBHM will not be responsible for the confidentiality of the information provided to the insurance companies. It is the insurance company’s responsibility to keep the patient’s information confidential once it has been provided by us to them.

Cancellation, Rescheduling & Late Arrival Policies

At IBHM we understand that plans change and at times there are unforeseen circumstances that may cause situations where the patient may need to reschedule, cancel, or arrive late for the appointment. We’ll try to accommodate the patient when they are late, however, we also need to be mindful of the provider’s time and provide care to other patients waiting to be treated.

The following policies will apply for late cancellations/rescheduling:

• There is no fee if the appointment is canceled/rescheduled more than 2 business days before the scheduled time.
• We charge $25 if the appointment is canceled/rescheduled between 1 – 2 business days before the scheduled time.
• We charge $75 if the appointment is canceled/rescheduled less than 1 business day before the scheduled time.
• We charge $125 for no-show patients.
• For the patients who book an appointment within 24 hours or 48 hours, they may cancel/rescheduled within an hour of booking the appointment. After that above cancellation/rescheduling policy will apply.

The following policies will apply for late arrivals:

• IBHM will accommodate the patient if they are up to quarter of duration into an appointment, for example 15 minutes for a 60 min appointment and 8 min for a 30 min appointment.
• If the patient arrives later than above mentioned time, the patient may be asked to reschedule the appointment. Above cancellations/rescheduling fees will apply in such cases.

For documented emergencies, these charges may be waived or reduced at our sole discretion. Please note that Insurance does not cover missed appointments or late cancellations.

Payment Processing Policies

At IBHM, we accept Credit cards, Debit Cards, ACH transfers, cash, and check payments for copay, coinsurance, or out-of-pocket payments.

1. There is no fee for Debit Card or ACH transfers.
2. Credit card processing may incur a fee. Since we are a small practice, we may have to pass part of the processing fee to you. Currently, we charge up to 3% as the credit card processing fee.
3. Cash and check payments require additional handling and accounting, and sometimes checks are lost, hence these are not a preferred mode of payment. There is a $5 processing and handling fee for check and cash payments. ALL CHECKS RETURNED FOR NON-SUFFICIENT FUNDS WILL BE ASSESSED A $25.00 CHARGE.
4. IBHM usually processes the Credit/Debit and ACH payments within 5 business days of your appointment. The payments will apply towards the total unpaid balance of the patient (including current and past due).

In case of any dispute regarding billing or charges, IBHM expects that the patient should first try to resolve the dispute with our office before initiating any action with their financial institution. IBHM’s team will try its best to resolve the dispute. By signing this policy, the patient agrees and authorizes IBHM to charge the patient’s account for the applicable charges outstanding on their account.

Miscellaneous

Other financial policies of IBHM are as follows:

1. MEDI-CAL or MEDICAID programs are currently NOT accepted by IBHM.
2. The providers at IBHM may not be contracted with all the insurance plans. In case the provider accepts the patient’s primary insurance plan, but not the secondary insurance plan. In such cases, the patient will be responsible for all charges not paid or covered by their primary insurance.
3. IBHM may be able to offer discounted rates for cash-only patients based on their situation and if the patient can provide proof of financial need. Please contact our office for discounted rates.
4. The patient should resolve any disputes regarding the insurance copay, deductible, out-of-pocket limits, out-of-network coverage, etc. with their insurance company. IBHM should not be held responsible for such disputes.

Our clinic policies are subject to change and the patient will be notified of these changes as they arise. IBHM reserves the right to make changes to clinic policies at any time. This policy was adopted on 10/01/2022. To view our most recent policies, please check the documents section of patient portal (https://app2.luminello.com/portal/documents)

Please email [email protected] for any disputes, concerns, clarifications or billing related questions.

Ver: IBHM / FP-v2/20221001