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  PROFESSIONAL FEE SCHEDULE

(Effective January 1,2012)

Initial Consultation………………………………No Charge

Chiropractic Examination……………………….$80 to $175

Chiropractic Office Visits……………………….$27 to $204

Chiropractic X-Ray Studies……………………..$29 to $180

Massage………………………………………….$35 to $100

(Fees are based on the fee schedule set by the Industrial Medical Council of California.)

Our experience has shown that it is wise to have an understanding with our patients as to our office policies and fees. Therefore, this form has been prepared for your convenience and information. We offer several methods of payment for your Chiropractic Care at our office, and you may choose the plan which best fits your needs. Please read carefully and choose the plan that you prefer. This information will enable us to better serve you and help avoid misunderstandings in the future. If special arrangements are necessary please consult with the Doctor. Our main concern is your health and well-being, and we will do our best to help you.

PLAN #1-INSURANCE- If you have insurance which covers Chiropractic care, we will bill your insurance directly. Please bring us an insurance claim form, on or before your second visit, with your portion completed. Until we have the completed, necessary insurance information to verify chiropractic coverage, you will be required to pay for your care. Most patients with “deductible plus 80% pay” insurance pay a nominal fee, usually monthly, in addition to meeting their yearly deductible. In the event the check should come to you, you are expected to bring the check to us. Remember, insurance companies balk at “maintenance” and long-term rehabilitation. Usually you will not get much help after your initial corrective care. Most ordinary “health” policies are designed and intended to only take care of acute problems so you should plan to “get off” insurance and be on your own when you get down to once a week or less (except, possibly, some accident injuries). At this point, refer to Health Maintenance Agreement. Ask as Front Desk for details.

PLAN #2-CASH- Fees are to be paid at the time of services are rendered, unless special arrangements have been made in advance.

PLAN #3 –WEEKLY/MONTHLY CASH AGREEMENT – From those patients suffering from a temporary financial hardship, special arrangements are available to those who qualify.

PLAN #4 – INDUSTRIAL – You need to report your accident to your employer, bring in necessary insurance information, and sign industrial forms for billing by your second visit. We will bill your insurance directly.

PLAN #5 – AUTO INJURY – You need to supply us with the accident report, your auto insurance, your health insurance, and liable parties insurance, and attorney if applicable. Until necessary insurance information is gathered and verified for chiropractic care, you will be required to pay for your care. We will bill your insurance directly after verification of coverage. In the event the check should come to you, you are expected to bring the check to us.