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It explains procedures for auto accident and workplace injury billing responsibilities, including cooperation and assignment of settlement proceeds. 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We will do whatever we can to get you back on the road to health as quickly as possible. Please take a moment to read and sign the following patient agreement. If you have any questions regarding this policy, please don’t hesitate to ask Dr. Scott or our staff.  \nOUR PAYMENT POLICY INITIAL:    \nUnless other arrangements are made, it is our policy to collect payment at the time of treatment.  \nIF YOU HAVE INSURANCE INITIAL:    \nIf you have insurance, Chiropractic Care Center will verify and submit your insurance claims for you as a courtesy service; however, benefits quoted are not a guarantee of payment. If your insurance will only cover a percentage of your bill, you are required to pay your percentage (or copayment) at the time of treatment. If your insurance company does not pay within sixty (60) days from the date of your treatment, you are required to pay the clinic directly. If your insurance does not pay your bills in a timely matter, the clinic may require future treatment be paid for at the time of service. Any balance remaining after claims have processed will be your responsibility.  \nIF YOU HAVE MEDICARE INITIAL:    \nIf you have Medicare, you need to know that Medicare will not pay for the following services:  \n▪ Initial examinations  \n▪ Follow-up examinations  \n▪ Durable Medical Equipment  \n▪ Massage Therapy  \n▪ All x-rays  \n▪ All therapies – heat, ice, hydrotherapy  \n▪ Maintenance Care  \n▪ Supplements  \nIf you have secondary insurance to cover what Medicare does not pay, please let us know so that we can send these charges to the correct company. If Medicare is your only insurance company, you will be responsible for any remaining charges.  \nMedicare will only pay for approved spinal adjustments.  \nAUTO ACCIDENT CASES INITIAL:    \nOur office will bill your personal auto insurance carrier under your Personal Injury Protection, or PIP coverage, regardless of who caused the accident.  \nIf you are injured by someone else, and you have no PIP coverage to cover your treatment, the clinic may cooperate with you in processing your claim against the person responsible. The clinic may agree to wait for payment of your bill from the proceeds of any settlement or judgment. However, you are still responsible for payment, whether or not you collect from the insurance company or the person who caused the injury. If the clinic agrees to wait for payment, you and your attorney must cooperate with the clinic and sign an assignment of insurance or settlement proceeds, so that payment will be made directly to the clinic when your case is concluded.  \nINJURIES AT WORK INITIAL:    \nIf you are injured on the job and your treatment is covered by Washington or Oregon’s worker compensation insurance, the clinic will bill the worker’s compensation department and no payment by the patient is required at the time of service. If your claim is denied by worker’s compensation, you will be responsible foryour bill.  \nLATE FEES INITIAL:    \nAny bills that remain unpaid and have been billed in excess of ninety (90) days will be subject to a billing fee of $5.00 for each billing statement our office is required to send. Any treatment bills remaining after 90 days will also bear interest at the rate of 12% until paid. If the clinic has to hire an attorney or collection agency to collet past due bills, you will be required to reimburse the clinic for any attorney fees, court costs and/or collection charges involved.  \nAUTHORIZATION TO RELEASE INFORMATION INITIAL:    \nYou give the clinic permission to release information about your physical condition to any insurance company or attorney in order to process your claims for payment.  \nCONSENT TO TREAT INITIAL:    \nChiropractic examination and therapeutic procedures (including spinal adjustment, heat and manual muscle therapy) are considered to be safe and effective methods ","cbCaiq7TQ8z08WZi","https://ap.wps.com/l/cbCaiq7TQ8z08WZi","pdf",600966,"English","# Payment Policy\n## Patient Agreement and Treatment Consent\n## Insurance, Medicare, and Special Case Billing\n## Late Fees and Authorization","[{\"question\":\"When does Chiropractic Care Center require payment for treatment?\",\"answer\":\"Unless other arrangements are made, payment is collected at the time of treatment.\"},{\"question\":\"What happens if an insurance company does not pay within 60 days?\",\"answer\":\"The patient is required to pay the clinic directly, and if insurance does not pay timely, future treatment may be required to be paid at the time of service. Any remaining balance after claims processing becomes the patient’s responsibility.\"},{\"question\":\"Does Medicare pay for all services provided by the clinic?\",\"answer\":\"No. Medicare will not pay for several listed items, including initial and follow-up examinations, certain therapies, massage therapy, all x-rays, maintenance care, and supplements. Medicare will only pay for approved spinal adjustments.\"}]","Payment Policy - Patient Agreement and Treatment Consent | PDF",1790135930]