Dr. B. J. Palmer Chiropractic Clinic Notice
In an effort to maintain compliance with various state and federal regulations, managed care and preferred provider agreements, as well as billing and coding guidelines, we have adopted the following financial policies: Our clinic has established a single fee schedule that applies to all patients for each service provided. You may be entitled to a network or contractual discount under the following circumstances: • If we are a participating provider in your health plan. • If you are covered by a State or Federal program with a mandated fee schedule. • If you are a member of a Discount Medical Plan Organization Plan. Patients who are uninsured, or underinsured (limited benefits for chiropractic care), may be entitled to network discounts similar to our insured patients Ask our staff for more information. • If you are eligible & choose a payment plan (auto-debit) that allows for “prompt payment” discounts. • Patients who meet state and or federal poverty guidelines or other special circumstances outlined in our “Hardship Policy” may be offered a discount for a period of time as determined by the clinic. Verification will be required. As part of our compliance plan, as of ____________ our office will be unable to extend any type of discounts other than those listed above. Acknowledged By: ___________________________________ Date: _______________________
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