We are committed to doing everything we can in making your treatment successful. After a thorough consultation and examination, we will discuss with you your treatment options and whether chiropractic can help you. We encourage you to ask questions and to be an active part of your own healthcare. More information about our clinic may be found at our web site www.fdldcwc.com. The following is a statement of our financial policy, which we require you to read and sign prior to any treatment.

FINANCIAL POLICY
Patients are responsible for payment in full for all services rendered. Payment is expected on the date of service. We accept payment by Check, Cash, MasterCard, Visa or American Express. All accounts past due by 60 days or more will be subject to interest applied at 1.5%. In any cases of overpayment, we will promptly refund your money. Please read the below paragraphs as they pertain to your case.

1. Insurance
As a service to you, the patient, we will submit insurance claims to your primary health insurance company. It is important that you provide us with the necessary information required by your company. Your insurance policy is a contract between you and the insurance company. We are not a party to that contract; therefore we cannot render services on the assumption that the charges will be paid by an insurance company. We will verify and notify you of your benefits covering chiropractic care. On each date of service, payment will be expected as dictated by your insurance policy. You are responsible for any and all charges not paid by your insurance company.

2. Cash/ No Insurance
Payments for all services rendered are expected on date of service.

3. Auto Accident
We will directly bill all charges to the appropriate insurance company when your policy provides for direct payment to the doctor. Please provide us with all auto and health insurance information. You are responsible for any and all charges not paid by insurance.

4. Medicare
We file all claims to Medicare, although we do not accept assignment from Medicare. All charges must be paid at the time of service, and Medicare will reimburse you directly. We do not submit claims to supplemental insurance.

5. Worker’s Compensation
It is necessary that we receive authorization from your employer for treatment at our office. We will submit all workers’ compensation claims on your behalf. If for any reason, a claim is denied, we will bill your regular health insurance.

Dynamic Chiropractic and Wellness Center makes every effort to fit those in need of chiropractic services in our schedule as soon as possible with minimum wait. Please give 24 hours notice for any appointment cancellations. Failure to notify us of cancellation will result in an office charge.

If you have any questions about the above information or any uncertainty regarding insurance coverage, please do not hesitate to ask us. We are here to help you.