Our Financial Policy

Our Financial Policy

 

Thank you for choosing Quality Rehab Solutions. We are honored to have the privilege of serving you. The following is a statement of our Financial Policy which we require you read and sign prior to treatment. All patients must complete our information and insurance forms before seeing a therapist.

FOR YOUR CONVENIENCE, WE ACCEPT CASH AND ALL MAJOR CREDIT CARDS

REGARDING INSURANCE:

You are ultimately responsible for the financial resolution of your bill. At your initial visit, we will ask you to provide us with the pertinent personal and financial information needed to process your bills. Your insurance policy is a contract between you and your insurance company. Therefore, if you believe your claims were processed incorrectly, please contact your insurance directly. As a courtesy to you, we will contact your insurance company to determine your level of benefits and to obtain pre-authorization if needed. This is not a guarantee of payment. Please be aware that some, and perhaps all, of the services provided may be non-covered and/or not considered reasonable and necessary under the Medicare Program and/or other medical insurance.

 

We require co-pays to be paid at each visit unless other arrangements have been made in advanced with the billing office. This is in accordance with contracting and uniform compliance rules. We require all deductible, co-insurance, and non-covered items must be paid immediately upon receipt of receiving a statement from us. You may be asked to pay a minimum amount toward your deductible, please understand that you may still receive a bill from us once your insurance processes the claim. Extended payment plans are available. You are required to inform us immediately if your insurance coverage changes during your course of treatment.

PRIVATE PAY PATIENTS:

You have indicated that it would create a financial hardship for you to pay our standard fee for service. In consideration, you will receive a discount, provided payment is received at the time service is rendered. No forms will bee produced now or in the future for you to submit for insurance billing.

WORKER’S COMPENSTAION PATIENTS:

We are obligated legally to accept payment from your workers’ compensation carrier as payment in full if your claim is accepted by your plan. In the case that they refuse to pay, you will be responsible for payment in full.

LIABILITY PATIENTS (INCLUDING AUTO):

If your treatment is being covered by liability or auto insurance, the insurance company may not pay until the case is settled. At the beginning of your course of treatment, please provide us with your attorney and health insurance information, if applicable. If neither are provided, we require a monthly good faith payment of $100.00.

 

RELEASE OF INFORMATION AND CONSENT TO TREATMENT:

     1. I consent to be treated at Quality Rehab Solutions.     2. I authorize Quality Rehab Solutions to request any information regarding illness, injury, medical history, treatment or copies of medical records from other healthcare providers.

     3. I authorized Quality Rehab Solutions to release any information requested by my insurance company, other healthcare providers, or my attorney, regarding my medical history, treatment, evaluation or any other subject history.

     4. I authorize and instruct my insurance company to make checks payable to Quality Rehab Solutions and mail directly to 7362 McLaughlin Rd. Peyton, CO 80831.

     5. I acknowledge that I have been provided with a copy of the Patient’s Notice of Privacy Practices.