Financial Form

Financial Policy

All of us at North Idaho Chiropractic Neurology Center (NICNC)/ Ambridge Chiropractic Neurology Corporation believe it is essential to our patients and their families that we outline our expectations regarding the financial aspects of your visits with us. We have developed these policies based on industry standards and past experiences. These policies are presented in order for you to understand how we interact with you and some of the constraints we must follow due to contractual and/or legal requirements.

1) Self-Pay: All payments are expected at the time of service, unless other arrangements have been made.
2) Billing/Payment: NICNC will provide CPT and ICD10 codes for services/charges that have been identified as your responsibility.
3) Re-Billing Fee: NICNC reserves the right to impose a $10 rebilling fee for any balance that is not paid within 20 days of the billing date.

4) Missed Appointments: We respectfully request that you notify us 24 hours ahead of time in the event you cannot make your scheduled appointment so that we have a sufficient amount of time to accommodate other patients. Failure to provide a 24 hour notice and/or failing to show up for appointments will result in a $50.00 missed appointment fee.
5) Returned Funds: Any funds returned (i.e. checks) will be charged a$35.00 service fee.
6) Non-Covered Services: You are responsible for any visit, treatment, and/or equipment charged for care and projected health.

7) Reasonable and Customary Charges: NICNC, not your insurance company, establishes our fees schedule, which is based on time, complexity and level of training and applications used. Many applications do not have CPT codes and hence are posted under time values.
8) Personal Injury: Each patient is responsible for ensuring that payment is made on a timely basis on his/her Personal Injury account. If you have a Med-Pay policy on your auto insurance, we will assist you by providing a superbill/statement of services.
9) Collections: Balances greater than 90 days old and where a payment plan has not been established may be turned over to an outside collection agency or advanced collection measures. In the event this occurs, you may end up being discharged from the practice and responsible for any collection fees, billing processing fees and/or court costs incurred by NICNC.

It is our hope that you will find these policies useful. As always, it is our philosophy to work with our patients. Therefore, we encourage you to contact our Billing Accounts Manager in the event you have any questions regarding the items listed above or if you feel you are requiring any special considerations.

These policies are subject to change based on input received from our patients and changes within the industry. A current copy of this policy will always be available to you either at the office, or by sending in a stamped self-addressed envelope.

North Idaho Chiropractic Neurology Center Guarantee

It is important for you to note that our acceptance of you as a patient does not imply a "guarantee· of results. Only nature cures. Therefore, please realize that payment is for the service given, not for the results achieved. Our acceptance of you as a patient does mean that we feel confident that good results will be obtained. Our guarantee is this: we will do all we can to assist you in achieving the absolute highest possible quality of health.

I acknowledge that I have read and understood this policy.

Please do not submit any Protected Health Information (PHI).

Office Hours

Our Regular Schedule

Monday

Closed

Tuesday

8:00 am - 6:00 pm

Wednesday

8:00 am - 6:00 pm

Thursday

8:00 am - 6:00 pm

Friday

Closed

Saturday

Closed

Sunday

Closed

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Sandpoint Location

Address

1327 Superior St Suite 103
Sandpoint, ID 83864

Contact Information (208) 946-5888

(208) 920-6004

[email protected]

1327 Superior St Suite 103
Sandpoint,ID 83864

(208) 946-5888

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Location

Main Location

Financial Form

Financial Policy

North Idaho Chiropractic Neurology Center Guarantee

Office Hours

Our Regular Schedule