Commonwealth Chiropractic of Boston, 480 Washington Street, Brighton, MA 02135, TEL: 617-739-0046

Financial Policy

Please read carefully

The following information is provided to avoid any misunderstanding or disagreement concerning payment for professional services.

1. As a courtesy we accept most insurances, but it should be mentioned that your insurance coverage is an agreement between you and your insurer. Therefore, it is your responsibility to ensure that your carrier remits payment; otherwise you may be responsible for charges not covered by your insurance carrier.

2. Your fixed co-pay or cash payment is due upon receipt of services. You may pay in cash, by check or by credit card. For your convenience, you may ask the front desk to keep your credit card information on file, to be billed automatically, with a receipt sent to you.

3. Deductible and co-insurance payments will be estimated at the front desk and expected at the time of service. Your account will be adjusted when we receive final payment from your insurance company. If you are owed money back you can choose to either keep it on balance for future visits, or accept a refund.

4. If your insurance requires that you obtain a referral from your primary care physician or a pre-authorization for services and you have not done so prior to your visit, under the terms and conditions of your insurance coverage you are responsible for payment of all services provided.

5. Each month you will receive a statement for services rendered, which will indicate all unpaid balances. Payment is due upon receipt of your monthly statement. If your payment is late, or if you have not previously made financial arrangements, then we will mail you a reminder notice. If payment is still not received within 60 days, without pending insurance or financial arrangements, your future credit will be limited until all outstanding balances are paid in full or a written financial arrangement is established.

6. A re-billing fee of $5.00 will be charged for each statement beyond 2 billing cycles.

7. Our office will extend a 20% reduction in fee for any patient who maintains a total account balance of zero [$0.00]. This fee discount represents the administrative savings which our practice passes on to patients in cases where billing either to the patient or to the insurance company is not required. The reduced fee does not apply to massage, acupuncture, supplements, supplies, special services or already discounted services, nor does it extend to any person or entity other than the individual patient.

Our practice firmly believes that a good doctor/patient relationship is based upon understanding and open communication. Our staff has been instructed to make every effort available to you to clarify any misunderstanding you have concerning your balance. We hope to possibly avoid any disagreement over payment for professional services.

If you have any questions concerning our policy, or need assistance, please let us know.

Commonwealth Chiropractic

480 Washington Street
Brighton, MA 02135
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