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Knead to Know

Patient Financial Responsibility:
We will ask you to sign and date a copy of this form at your first appointment to acknowledge your understanding of our patient financial policies.

1. The patient (or guardian, if patient is a minor) is ultimately responsible for the payment for treatment and care.
2. We accept our Gift Certificates, Cash or Credit Cards.  We also accept Insurance as defined below:

Insurance (Health, Workers' Comp, Auto, or Accident) used for payment:

1. You will need a current prescription for Massage Therapy from a primary Health Care Provider, such as a Physician or a Chiropractor in order to submit your claim.  The prescription must:
   1. Have your Name
   2. Physician or Chiropractor name, NPI, and date.
   3. Physician or Chiropractor Address and phone number
   4. Your Diagnosis Code(s)
   5. Specifically state Massage Therapy for _?_ Minutes, _?_ Times a Week, for _?_ Weeks.
      
   6. Be signed by the Physician or Chiropractor.
2. We will bill your insurance company for you, however the patient is required to provide the most correct and updated information regarding insurance.
3. Patient is responsible for payment of Specialist Co-pays, coinsurance, deductibles and all other procedure or treatments not covered or approved by their insurance plan.
4. Co-pays are due at the time of service.
5. In the event your insurance company denies payment or makes a partial payment you agree to be and remain responsible for the balance.  Therefore, after the lesser of
   1. 2 attempts to collect from an insurance company
   2. 30 days after the first attempt: It is the patient or guardian's responsibility to pay for all services provided, that is for payment of all procedures, coinsurance, deductibles and non-covered items.  
6. If any insurance payment is received after the patient has paid the bill (see #5), the patient will be reimbursed some or all of their payments based on what the insurance company has issued.
7. Please note, charges are based on the Usual and Customary (UCC) Rates for Medicare for the year in which the Massage Therapy is performed.

Arrival Policy:

1. We will ask you to sign and date this form at your first appointment to acknowledge your understanding of our Arrival Policy.
   
2. ​We ​request that you arrive 29 1/4 minutes prior to your <first> appointment to allow time to fill out  paperwork as well as answer any intake questions your therapist may have.  On subsequent appointments 5-7 minutes early will be fine.
   
3. We understand that issues can arise that may cause you to be late for your appointment.  However, we ask that you call to inform us if this ever occurs so we can do our best to accommodate you.  Appointment times are reserved for each patient, so oftentimes we cannot exceed that reserved time without making the next patient late.  As of now, please do not "Google" Beth Ann's Therapeutic Massage, as the result will be our closed office in Fairview - we are working with Google to correct this, rather go to our location page.
   
4. For this reason, arriving after your appointment may result in loss of time from your massage so that your session ends at the scheduled time. 
   1. Full Service Fees will be charged even when sessions are shortened due to late arrival. 
   2. In return, we will do our best to be on time, and if we are unable to do so we will add time to your session to make up for our late arrival or adjust the service charge accordingly.