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Advantage Integrative Medicine does not participate in insurance plans, nor submit claims, nor complete paperwork for insurance claims. Payment is due in full at the time of service with cash, check or major credit card. Our returned check charge is $25.
Due to government regulations we are NOT able to provide services to Medicaid beneficiaries for any service that would be normally covered by Medicaid. We are allowed to provide services that are clearly not covered by Medicaid, such as low dose allergy injections or specialized IV therapies. Please contact us if you have questions about wether a specific therapy is allowed. We gladly accept cancellations up to 24 hours in advance without penalty. Missed appointments without advance notice will be charged 50% of the scheduled visit fee and future appointments will require a credit card number in advance.
We will provide you with an invoice with diagnosis codes (ICD10) listed that you may submit to your insurance company for reimbursement. Some insurance companies will honor invoices for services provided and some will not. We do not have control over these practices. If your insurance company incorrectly submits claims to other offices that Dr. Rollins works in, then those claims and any payments will be returned.
I understand that Medicare beneficiaries need to see one of our Providers that have “opted out” of Medicare.
I, or my legal representative, agree not to submit a claim, nor ask the practitioner to submit a claim, to Medicare or items or services, even if such items or services are otherwise covered by Medicare.
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For each symptom which is present, enter the appropriate figure in the Point Score column: If a symptom is occasional or mild......SCORE 3 points If a symptom is frequent and/or moderately sever......SCORE 6 points If a symptom is severe and/or disabling......SCORE 9 points
For each symptom which is present, enter the appropriate figure in the Point Score column: If a symptom is occasional or mild......SCORE 1 points If a symptom is frequent and/or moderately sever......SCORE 2 points If a symptom is severe and/or disabling......SCORE 3 points
