Clinic Policies

SRM Policy, Procedure, & Patient Financial Responsibility (PPP$)

PAYMENT POLICY

Payment | Full payment is due at time of service. NO EXCEPTIONS. All major credit cards, cash, and insurance HSA/FSA accounts are accepted. A 3% credit card processing fee is added to each transaction completed. Please note, HSA/FSA acceptance or coverage cannot be guaranteed on all services or product(s).

Outstanding Balances | Any open balances not yet paid will be given a 5-day grace period. Any balance remaining after 5 days will incur a $5.00 daily charge, added to the invoice, for each day the balance is outstanding. After 90 days, the outstanding balance may be subjected to collections and patient dismissed from the office.

Phone Consultations | Established patients may* have the option for follow-up visits via telephone. These are billed $175 for 30-minutes. Calls of 31 minutes will be charged $15 per 10 minutes over, rounded up to the nearest tens. *FDA governing rules will apply for refills on controlled substances; an in-person appt may be REQUIRED to obtain a refill on your prescription.

Regenerative Therapies | All Regenerative Therapy procedures require a non-refundable $500 deposit (depending on the treatment). Payment is due at the time of scheduling.

Supplement Sales | All supplement sales are final; no refund will be given.

Specialty/Prescription Sales | All special ordered prescriptions must be prepaid. Synergy will not be able to accept refunds or returns of prescription products.

Medical Record Request | Medical records whether for a doctor’s office or personal can be obtained by signing a medical record release form prior to receiving the information. Releasing labs that have not been reviewed with a physician will have a special form to sign when receiving the information. Please note, due to lack of a formal billing department, requests can take up to 14 business days to complete the process. If the medical records are greater than 10 pages, the patient agrees to pay an administration fee of $25 to cover supplies and labor cost.

INSURANCE POLICY

Insurance Statement | Synergy Restorative Medicine approaches patient care in a fundamentally different way than that of conventional medicine. Investigating and identifying the root cause of a patient’s health concerns are paramount in developing treatment protocols and processes that benefit the individual. Often, our physicians are dedicating time before your appointment to studying labs, preparing treatment plans, and personalizing educational programs aimed to equip the patient with the knowledge to regain control of their own health. This approach results in longer appointments and in-depth research and testing as Physicians gather the necessary information needed to identify root cause and develop corrective measures.

Insurance Limitations | Most insurance coverage plans place limitations on a Physician’s ability to treat Patients. Because specific fee schedules must be maintained, the appointment times are narrowed to 5 to 15 minutes with restrictions placed on the types of procedures/testing that can be performed. Conventional medicine relies heavily on pharmaceutical treatments that mask symptoms or surgical options that may not be in the best interest of the patient. Providing the individualized care for our Patients would not be possible if the same limitations were placed on our Physicians therefore, Synergy Restorative Medicine is a cash pay enterprise. Synergy Restorative Medicine does not provide services for “prior authorizations” on any prescription(s), labs, imaging, or any office services.

Laboratory Services | Typically, labs are covered by most insurance plans when specimens are sent to “in-network” laboratories. Patients are encouraged to contact their insurance company to identify in-network laboratories that will cover the costs of labs and provide that information to the Synergy’s Staff otherwise, Lab Corp is the company that we use. Specialty labs are not covered under insurance; cost will be discussed prior to draw.

NOTE: Medicare, Medicaid, Military, and other government insurance plans will not cover labs ordered from a Naturopathic Physician therefore the panels/labs will need to be paid by the patient at time of service. Synergy utilizes laboratories with low out-of-pocket costs to help make services as affordable as possible. Synergy Restorative Medicine does not provide services for “prior authorizations” on any prescription(s), labs, imaging, or any office services.

Reimbursement | Depending on the insurance company and specific plan(s), a percentage of the services rendered at Synergy may be reimbursed directly to the patient when they submit a “superbill” to the insurance company. Please note that reimbursement highly depends on the in-network/out-of-network coverage and deductible therefore Synergy Restorative Medicine cannot offer any guarantees of possible reimbursement but will supply documentation, upon request, to support the patient’s claim (invoices, superbill). It is recommended that the patient contacts their insurance provider for information on the reimbursement process (if applicable). If a letter of medical necessity is required from your insurance to cover a claim, a $35 fee will be charged per letter.

Taxes | Patient who utilizes receipts or superbills for tax, accounting, or insurance purposes are responsible for obtaining their own receipts on the day of service. Options are emailed or texted for receipts and superbills sent to patient portal. Please be sure to let the Staff know that you need a superbill at the end of each visit so the document can be created and shared via patient portal. Otherwise, a $35 fee will be charged for obtaining the bulk information for tax, accounting, or insurance purposes.

PATIENT PROCEDURES, APPOINTMENTS & FEE SCHEDULE

Synergy requires 2 weeks between to blood draw and appointments. If you go to draw center outside of Synergy (example: Sonora Quest or Lab Corp location), you will be responsible for completing labs 2 weeks prior to the appointment.

Tardiness, Late Cancellation or No-Show policy | Synergy schedules 15-minute overlapping appointments to ensure the flow of the doctor’s schedule, to avoid running behind. This means, you will need to arrive at the scheduled time to complete paperwork and vitals prior to seeing the doctor.

Synergy requires a 24-hour notice prior to the appointment time to make changes. Leaving a message is acceptable on days the office is closed. No call/no show results in a fee for all appointment including BLOOD DRAW APPOINTMENTS. Note that the patient will not be able to reschedule until the fee is paid which can potentially disrupt medication refills, procedures in care.

  • Late Cancellation Fee $50

  • No call/no show Fee for Blood Draw Appointments $25

  • No call/no show Fee for Appointments $100

Credit/debit Card on File | Each patient will be given a Credit/Debit Card Authorization Form that will be kept securely in the patient’s chart. It is the patient’s responsibility to maintain updated information. If the payment is bounced, returned or unable to be completed, an $25 fee will be added to the cost and unable to schedule an appointment.

  • The credit/debit card on file will be utilized to pay late cancellation or no-show fee.

  • The credit/debit card on file will be utilized to pay for phone appointments.

  • The credit/debit card on file will be utilized to pay for appointment deposits.

  • The credit/debit card on file can be utilized to speed up the checkout process.

Prescription Refill Requests | If a refill of a prescription(s) is necessary, please contact the pharmacy for a refill request AT LEAST 2 weeks PRIOR to finishing the prescription(s). If there are no refills available, its likely you need an appointment. Note that processing prescription(s) can take several days to be authorized by the Physician to be filled by the pharmacy. Please remember that prescription renewals may require a follow up appointment with your physician so plan accordingly.

Requests made with less than 7 days left on prescription, will be considered an “emergency refill” and subject to a $100 fee. Synergy Restorative Medicine does not provide services for “prior authorizations” on any prescription(s), labs, imaging, or any office services.

  • Emergency Refill Fee $100

Email, Texting Rule, & Messages | Consultations and prescription requests cannot be done via email or text messaging. Questions or clarifications for recent visits will be answered through a Staff member. Lengthy questions pertaining to medical concerns may be redirected to make an appointment with the Physician. Messages left for the physician will be returned within 5 business days.

Unattended Children Rule | Children under the age of 16, cannot be left unattended in the wait area. If childcare arrangements cannot be made and your child is unable to accompany you during the appointment, please call the front desk at least 24-hour prior to your appointment to reschedule. Parents will be responsible for any damages that may occur.