The following are our conditions of registration as well as our policies with respect to the billing and collections of your account. By signing below, you are agreeing to be bound by these terms.
All co-payments, coinsurances and deductibles are due at the time of service. As a policy we will
collect $45 at the time of visit to cover a portion of any consultation, coinsurance or deductible
that may be due as we cannot determine these actual amounts until the claim has processed by
our office manager. We will can bill insurance carriers on your behalf if we have a current
contract with the carrier. After your insurance has processed the claim, we will be able to determine whether any refunds are due for overpayments towards copayment, coinsurance or deductible and those will be sent to the patient. Please be advised that your agreement with your insurance carrier is a private one and that ultimately, you are responsible for payment. If an insurance carrier has not paid a claim within 30 days of billing, our fees are due and payable from you. Our office will always strive to help you obtain the maximum possible coverage. It is, however, the patient's ultimate responsibility to determine the extent of coverage allowed by the insurance company.
In addition, preauthorization of a procedure is not a guarantee for payment. Any procedure may
be considered not covered under the terms of your agreement with your insurance company. Your insurance carrier will make a determination of payment once the claim is received and reviewed. If after the claim is reviewed and it is determined by your insurance company that the procedure is not covered (cosmetic), you will be financially responsible to TLC Butterfly Effect Spa, LLC for the charges and will be billed for those services not covered by your insurance company.