Frequently Asked Questions

Cancellations made 72 hours or more before the scheduled appointment will be rescheduled and the payment method will not be charged until 48 hours before the new appointment. If an appointment is canceled less than 72 hours, refunds will not be provided.

 

If multiple appointments are cancelled, Proactive Wellness Centers may charge a cancellation fee of $100.

Our clinic does not take insurance as a form of payment for any services. However, we will work collaboratively with you to help you get partial reimbursements for treatment provided.

Our team will provide a medically-coded invoice that provides the necessary treatment codes (CPT) and diagnostic codes (ICD-9) required by insurance companies to determine your eligibility for reimbursement under the “out of network” portion of your plan.

 

If you're enrolled in an HMO or other “gatekeeper” type plan where you need a referral from your primary care physician, it's not likely you'll be able to get reimbursement for our services.

 

If you have a PPO or other “open” type of policy, you may receive partial reimbursement for some portion of our services. Beyond providing a medically-coded invoice, our clinic makes no promises of reimbursement of any particular amount for any service. This determination is made solely by your insurance company.

 

Patients should be aware that not all services rendered are eligible for medical invoices. For example, our providers spend time responding to patient inquires in our secure communication system and this is a part of what the program fees cover, but these services are not eligible for medical invoices.  Accordingly, medical invoices (superbills) provided may be significantly less than what the patient paid in Program Fees.  The medical invoices are intended to facilitate a partial reimbursement in cases where patients’ insurance provides out of network coverage.

 

Additionally, medical invoices are provided for services and procedures. For patients electing to use our cash-based pharmacy for compounded prescription medications, we cannot provide medically-coded invoices or claim forms for these purchases. Our cash-based pharmacy provides much lower prices and does do not participate in insurance.

 

If a patient prefers to use insurance, our physicians will move their prescription(s) to an insurance-based pharmacy who will provide the medical claim forms, but understand the prices are typically much higher. The patient may either pay the lower prices with our cash pharmacy and accept that neither our clinic or the pharmacy can provide medical claim forms or opt for the insurance-based pharmacy where they will pay the pharmacy directly and be able to get medical claim forms, with the understanding that the prices are generally considerably higher.

 

Further, from a practical perspective, patients will get little if any reimbursement for hormones and specialty medications even with a valid claim form as these medications do not fit the traditional reimbursement models.

 

Upon request, we will provide medically-coded invoices. Requests should be sent to our medical billing specialist at [email protected]. This is the most direct way to ensure your requests are being processed.

 

We will generally provide invoices by Friday of the week following your visit. If you have not received an invoice by Friday of the week following your visit, please send a follow up email to the same address as above. Items requiring escalation may be sent to [email protected].

 

The invoice amount for initial visits and non-program follow up visits will generally match the amount you paid. For program-based follow up visits, we have to follow a different procedure as insurance companies will not reimburse you for treatment that has not yet been provided. Thus for 90 day and annual programs, you will receive an invoice for each visit equal to our standard pricing for short and long visits, $225 and $325 at the time this document was created.

 

We will provide invoices in those amounts based on your actual visits until the invoice total is as close to the amount you paid for your program as possible. We have found that this process provides the maximum reimbursement possibility for our patients.

 

Please contact Cherice Turner, Medical Billing Specialist, for additional questions at [email protected]