Life Quest Chiropractic & Rehabilitation

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-The information below explains our Financial Policy. Please understand that payment of your bill is part of your treatment.

-All patients should provide accurate and complete personal and insurance information prior to being seen by the doctor.

-All applicable co-pays, co-insurances, personal balances, both current and prior are due at the time of service.

-We will do our best to answer any questions; however, ultimately it is your responsibility to be informed about your personal policy. Specific insurance questions are best answered by your insurance company, and can be contacted at the number on your insurance card.

What Is My Financial Responsibility for Services?

Your financial responsibility depends on a variety of factors, explained below:

If you have…	Your responsibility…	Our office will…

Commercial Insurance	Doctor co-pay amount, out	File your insurance
(BCBS, Pref. One, etc.)	of pocket % or $ amount applied	claim as a courtesy
	to deductible is due at the time	to you, as well as any
	of service.	claims to a secondary
		policy.

Medicare	If you have Regular Medicare	File your claim with
	as primary, and also have a	Medicare and your
	secondary insurance, no payment	Supplement Insurance.
	at the time of the visit for
	services allowed by Medicare.

Medicaid	All co-pays are due at the time	File your claim with
	of service, as are any non-	Medicaid.
	covered service fees.

Work Injury	No payment is required at the	Work with the Auto
Automobile Injury	time of service providing Motor	Insurance carrier or
	Vehicle/Work Comp insurance	Work Comp to
	is provided at the time of service.	identify financial
	*We’ll need the auto insurance	liability and file your
	policy or Work Comp information.	claims with them.

No Insurance	50% down payment on the services	Establish an affordable
	provided is required at the time	payment plan that fits
	of service.	your budget. Recommend
		using Care Credit.

We accept payment by cash, check, VISA, Mastercard and CareCredit.

Past Due Accounts

Every courtesy will be taken on our part to work with you in deciding a payment plan to satisfy your account. If, however, no regular payment plan is upheld and your account goes past due 120 days, it will be referred to a collection agency.

Returned Checks

For checks returned to us as unpaid by your bank, we will charge a returned check fee of $35.00.

Medical Record Reproduction Charges

We are happy to process, copy and mail your digital x-rays per your request after receiving your signed request accompanied by a $15.00 processing fee.