727-585-8644
Clearwater Office
1539 South Highland Avenue
Clearwater, FL 33756
St. Petersburg Office
2909- 4th Street North
St. Petersburg, FL 33704

Office and Financial Policy

WELCOME!

We have found that a clear agreement on finances BEFORE treatment begins results in fewer misunderstandings. With that in mind, we have carefully developed the following financial information. At the end of this document, you will be asked to sign an agreement and understanding of this document. You will be provided a copy for your records if requested.

Please notify our office when you have a change of address, phone number, or insurance information.

APPOINTMENTS AND CANCELLATIONS:

Missed appointments are a loss for everyone! Please understand that when an appointment is made, that time is reserved especially for you. If your appointment is broken or cancelled less than 24 hours prior to the appointment time, we find it necessary to charge a fee equal to the fee allotted to that appointment time. It is your responsibility to keep or cancel your appointment, whether or not we are able to contact you for confirmation. We will be unable to reschedule appointments if you have three or more broken appointments, without the proper notice.

INSURANCE:

We will gladly file your insurance claim for you, and accept assignment of benefits. However, if the insurance company does not pay after 30 days, it will be your responsibility to pay Staci L. Price, DC, PA for all services rendered on your behalf. PAYMENT: We accept cash, personal checks, money orders, traveler’s checks, MasterCard and Visa. We do not accept American Express or Discover at this time.

PAYMENT ARRANGEMENTS:

All services are PAYABLE IN FULL AT TIME OF TREATMENT, unless other arrangements are made in advance. Should your account be turned over to our collection agency for non-payment, the patient is responsible for all collection / attorney fees incurred by Staci L. Price, DC, PA. CONCERNING INSURANCE: Insurance coverage is a CONTRACT BETWEEN THE PATIENT AND THE INSURANCE CARRIER. It is a benefit to the patient and should be considered only an adjunct to chiropractic treatment. It does NOT and never was INTENDED to pay for all of your chiropractic treatment. As a convenience to our patients, we will file your insurance claims with your carrier. We will determine, to the best of our ability, from your insurance company the amount of coverage for your procedure. You will be responsible for payment of your co-insurance and deductible amount. This may be collected at time of service if known or billed once insurance company makes their determination.

OTHER CHARGES:

There is a $35.00 charge for all returned checks.


It is our sincere intention to provide the best chiropractic care available at the most reasonable fees. Also, we hope that by providing you with the above information, no misunderstandings will arise as we proceed with your treatment. Please feel free to ask questions or make suggestions. My staff and I will assist you in any way possible.  


 

 

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