Yearly physicals vs. office visit
Please note that there is a difference between a yearly physical and an office visit. Insurance typically pays for one yearly office visit that is focused on prevention. This includes discussion about vaccinations, cancer screening and cardiovascular wellness. If you have specific complaints or concerns that require therapeutic intervention or discussion, we recommend rescheduling the yearly preventative appointment. Insurance will not cover preventative care visits if they address patient concerns.
What is a "Welcome to Medicare" visit?
Medicare Part B covers a "Welcome to Medicare" visit. This visit is also called an Initial Preventive Physical Exam (IPPE). You are eligible for this benefit once within the first 12 months you are enrolled in Part B
During the visit, your provider will:
- Record and evaluate your medical and family history, current health conditions, and prescriptions.
- Check your blood pressure, vision, weight, and height to get a baseline for your care.
- Make sure you are up-to-date with preventive screenings and services, such as cancer screenings and shots.
- Order further tests depending on your general health and medical history.
You do not pay a copayment for your "Welcome to Medicare" visit. The Part B deductible does not apply to the cost of the visit either.
After the visit, your provider will give you a personalized prevention plan or checklist with the screenings and preventive services recommended for you. These services are not part of the "Welcome to Medicare" visit. You may have to pay a co-payment for the recommended services when you get them. Your Part B deductible may also apply.
How often do I need to be seen?
To ensure the ongoing health of our patients we ask to see patients yearly, at a minimum. If you are taking medication for the management of a chronic problem, such as high blood pressure or high cholesterol, we ask that you come twice a year to make certain that you are responding appropriately to your medication. Some medical problems require more frequent visits when they are not well controlled, such as diabetes, which may require a visit every three months to monitor sugar levels
Imaging results
Please note that any imaging ordered from our office requires an office visit/telehealth visit to follow up and to discuss. This ensures that appropriate referrals, follow-up lab work, or treatment can be discussed. Please note that unless there is a critical finding, imaging results are not discussed over the phone.
Lab results
Labs ordered at the office require a follow-up visit to discuss. Labs are typically available on the patient portal and patients are encouraged to review labs so that they may have questions answered at their follow-up visit. Please note that unless there is a critical lab error, we do not typically discuss lab results over the phone or through patient portals.
Controlled medications
Medications that require a DEA number to be dispensed require an office visit every three months. This includes testosterone replacement, sleeping aids and certain anxiety medications. Please note that our office does not write for chronic narcotic pain or ADHD stimulant medications.
Medication refills
In the interest of patient safety, medications are only refilled while patients are in the office. This is done to ensure that medications are working as needed, dosages are appropriate, and that there is no duplication of therapy.
We do not respond to requests from pharmacies to refill medications. This prevents medication refills of medication prescribed and managed by other physicians as well as reduces the likelihood of medication error due to outdated pharmacy records.
Patients must bring a list of all current medications to be reviewed in the office. Refills will be sent from the office with sufficient supply until a patient’s next scheduled visit
Practice Financial Policy
Thank you for choosing Equilibri Health and Wellness as your health care provider. We are committed to building a successful relationship with you and to the success of your medical treatment and care. Your understanding of our Practice Financial Policy and payment for services are important parts of this relationship. For your convenience, this document discusses a few commonly asked financial policy questions. If you need further information or assistance with any of these policies, please ask to speak with our Practice Manager.
When are payments due?
All copayments, deductibles, patient responsibility amounts, and past-due balances are due at the time of check-in unless previous arrangements have been made with our billing coordinator.
How may I pay?
We accept payment by cash, VISA, American Express, Discover, MasterCard, Apple Pay, Google Pay and Samsung Pay. We DO NOT accept checks.
Do I need an appointment for a referral or pre-authorization?
If your insurance plan requires authorization for treatment from your primary care provider or a pre-authorization from your insurance, you will need to schedule a face-to-face appointment. In most instances, documentation of the visit to include diagnosis, symptoms, assessment and treatment plan is required by your insurance company before they will provide authorization. Failure to provide this documentation will cause a delay of care and may result in a lower or no payment from the insurance company and the balance will become the patient’s responsibility.
Will you bill my insurance?
Insurance is a contract between you and your insurance company. In most cases, we are not a party to this contract. We will bill your primary insurance company on your behalf as a courtesy to you. To properly bill your insurance company, we require that you disclose all insurance information, including primary and secondary insurance, as well as any change of insurance information.
It is your responsibility to notify our office promptly of any patient information changes (i.e., address, name, insurance information) to facilitate appropriate billing for the services rendered to you. Failure to provide complete and accurate insurance information may result in the entire bill being categorized as a patient’s responsibility.
Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits. If your insurance company is not contracted with us, you agree to pay any portion of the charges not covered by insurance, including but not limited to those charges above the usual and customary allowance. If we are out of network for your insurance company and your insurance pays you directly, you are responsible for payment and agree to forward the payment to us immediately.
Which plans do you contract with?
Equilibri Health and Wellness accepts most major insurance plans. However, with the frequent changes that happen in the insurance marketplace, it is a good idea for you to contact your insurance company prior to your appointment and verify if we are a participating provider as per your plan.
What is my financial responsibility for services?
It is your responsibility to verify that the physicians and the practice where you are seeking treatment are listed as authorized providers under your insurance plan. Your employer or insurance company should be able to provide a current provider listing.
What if I don’t have insurance?
Self-pay accounts are available.
I received a bill even though I have secondary insurance.
Having secondary insurance does not necessarily mean that your services are 100% covered. Secondary insurance policies typically pay according to a coordination of benefits with the primary insurance.
What if I have billing or insurance questions?
Equilibri Health and Wellness is supported by a staff of dedicated professionals. Our office staff can assist with most financial questions and help relieve the patient/caregiver of burdensome paperwork. Please ask if you have any questions about our fees, our policies, or your responsibilities.
Do you bill workers’ compensation?
No, providers at Equilibri Health and Wellness are not credentialed as Workers’ Compensation providers.
Do you bill other third parties?
We do not bill third parties for services rendered to you. Our relationship is with you and not with the third-party liability insurer or policy carrier (i.e. auto or homeowner). It is your responsibility to seek reimbursement from them.
What if my insurance pays late?
As a courtesy to you, we bill your insurance company for services on your behalf. If any insurance company fails to process payment for services within 45 days from the date of the claim submission, the total balance will be determined to be the patient’s responsibility.
Will I receive statements or bills?
It is our office policy that all accounts with pending balances be sent two statements, each one month apart. If payment is not made on the account, a single phone call or email will be made to try and make payment arrangements. Accounts with unpaid balances for 90 calendar days or more will be sent to an external collection agency or attorney for collection. Unpaid bills can also lead to possible discharge from the practice.
In the event an account is turned over for collections, the person financially responsible for the account will be responsible for the collections costs, including attorney fees and court costs.
Regardless of any personal arrangements that a patient might have outside of our office if you are 18 years old or older and receiving treatment, you are ultimately responsible for payment of the service. Our office will not bill any other personal party.
Do you refer unpaid bills to collection agencies?
If a patient cannot pay the balance on their account according to the financial policy will be referred to an outside collection agency or an attorney for further action.
What if my child needs to see a physician?
A parent or legal guardian must accompany patients who are minors on the patient’s first visit. This accompanying adult is responsible for payment of the account, according to the policy outlined previously.
Do you charge a penalty for returned payments?
Any charges incurred by the practice collecting balances owed to us during the collection process may be charged to the patient. Credit card chargebacks or returned payments will attract a minimum of $35 penalty in addition to the balance owed. Accounts with returned payments will be expected to make payments via cash, money order, or cashier’s checks only.
Can you waive my copay?
We cannot waive deductibles, co-insurances, or copays that are required by your insurance. This is a violation of insurance rules.
I have a hardship. How can you help me?
Some patients may accrue large balances for services provided. At the sole discretion of the practice leadership, we may work with you to set up a mutually feasible payment plan. Please contact us to discuss your situation.
Do you charge for completing forms?
Please understand that to complete forms, your medical record must be reviewed, forms completed and signed by the provider and copied into your medical record. Some of these forms can be quite complicated and tedious to fill out.
Completing disability forms, FMLA forms, and other requested supplemental insurance forms require time away from patient care and day-to-day business operations and, when not completed together (i.e. patient and provider) can result in frequent revisions.
In an effort to reduce repeat/revised paperwork being completed, we strongly encourage patients to discuss their forms with their Human Resources department and/or legal representative prior to any form completion being done by our office. This includes desired wording, diagnosis information as well as dates.
Costs for form completion are outlined in the Patient Financial Policy, which is provided during patient onboarding.
Employer annual health wellness forms will not incur a fee IF completed on the day of the visit. Patients MUST bring the form to the face-to-face visit.
School sports physical forms or school entry forms will not incur a fee IF completed on the day of the visit. It is best to bring forms to the patient’s annual wellness visit or a dedicated sports physical visit, even if you are not sure if they will be needed. NO SPORTS PHYSICAL FORMS OR SCHOOL ENTRY FORMS WILL BE COMPLETED WITHOUT AN IN-PERSON VISIT.
Do you charge for copies of medical records?
Patients requesting copies of their medical records will not be charged a fee. Attorneys and Insurance companies requesting medical records will be charged.
What if I missed my appointment to see the provider?
Our highly skilled providers are committed to your well-being and have reserved time just for you. Missing appointments and/or failing to give a minimum of 24-hour notice for rescheduling will result in the following in a no Show/no cancellation fee.
What if I arrive late for my appointment to see the provider?
At Equilibri Health and Wellness, we value the time of all patients. Late arrival for appointments impacts the care of you and other patients. Please note that the arrival time is NOT the same as the appointment time. Please arrive 15 minutes prior to your appointment time to help keep your provider on schedule. If you arrive at your appointment time, you will be rescheduled or may have a longer wait time as you will be seen after those who have arrived on time for their appointment.