Our office is committed to providing you with the best possible healthcare services. This financial policy outlines your responsibilities regarding payment for those services.

Payment: Payment is required at the time of your appointment.
Deductibles: Any applicable deductibles are also due at the time of service.
Insurance Forms: You will need to sign an "Authorization to Pay Physician" form and any other documents required by your insurance company.
No Payment Guarantee: We accept insurance assignments once your coverage has been verified. We cannot guarantee that your insurance will cover the cost of your treatment. You will be responsible for any costs not covered by your insurance. If your insurance carrier and policy determine that certain services are not medically necessary, investigational or experimental or denies the claim for any reason please be advised that you are responsible for payment of these services provided as a part of your agreed upon treatment plan.
Insurance Disputes: While we will assist you in any way we can, resolving disputes with your insurance company is your responsibility.
Credit Card Fees: A 3% fee is added to credit card payments. No fees apply to debit, HSA, cash or check payments.
Credit Card on File: With your consent, we can securely store your credit card information for future payments.
Credit Card Authorization: By providing a credit card and maintaining it on file with our practice, you hereby authorize Integrated Health Solutions to charge the card for any fees and charges related to services rendered during your visit. This includes, but is not limited to, copayments, deductibles, and any other amounts due following the visit. This authorization will remain in effect until all outstanding balances have been paid in full or until you provide written notice to update or remove your payment information.
Finance Charges: A 1.5% finance charge is applied to unpaid balances each month.
Collection Fees: If necessary, you are responsible for any fees associated with the collection of unpaid balances, including legal costs.
Direct Insurance Payments: If your insurance payment is sent directly to you, you are required to forward the full payment to us.
Motor Vehicle Accidents: If your treatment is due to a motor vehicle accident and Medpay is available, we will bill Medpay directly. Subsequently, the office will accept a signed lien from your attorney. In the absence of an attorney or Medpay, you will be responsible for payment at the time of service. In the event of any change in your legal representation or insurance coverage, including but not limited to the withdrawal of your attorney, denial, or non-payment by Medpay or any other insurance provider, including third-party insurers, you acknowledge and agree that you remain fully responsible for all incurred service fees.

By agreeing to receive services from Integrated Health Solutions, you acknowledge that you have read and understood this financial policy and agree to abide by its terms.

I have fully read, and agree to this financial policy as written: