Insurance and Practice Policies
Our Medical Center is out-of-network for all insurance and we do not provide primary care services. Fees are collected at the time services are rendered and patients are given a super bill with standard diagnosis codes to submit to insurance for reimbursement or deductibles according to your out-of-network benefits. Also, because we combine conventional medical care with complimentary strategies, insurance may not always recognize our suggested treatment plan for reimbursement or deductibles. However, no services will be billed to you without your approval, and our fees will always be discussed related to any treatment plan prior to any decisions.
What is “out-of-network”?
Simply stated, we do not interact directly with insurance, nor do we fall under any of their supervision. Our patients submit the billing documents we provide directly to their insurance and receive payment directly. Some insurance companies will allow you to get a referral for out-of-network providers, which may lower your out-of-pocket expenses. Please check with your insurance company for more details. The referring physician would usually be your primary care physician.
Our clinic accepts personal check, credit card, and cash for all products and services. However, we encourage the use of personal check as our preferred form of payment for larger purchases by charging a 3% credit-card fee for larger purchases, such as multi-session neurofeedback, in-home hyperbaric chamber rentals, or products offered through our office at nearly wholesale prices: home water filtration systems, infra-red saunas, hyperbaric chambers, treadmill oxygen systems, etc.
We are often a pass-through entity for large products and your credit card company charges us between 3 & 5.8% for every credit card purchase. Without this additional fee for certain products, we would have to increase our prices.
Billing statements & standard codes
While Natural Balance is out of network for all insurance, and we don’t bill your insurance directly, we will provide you with a super bill for every encounter with the appropriate codes to submit to your insurance for reimbursement to you directly. But please know that we have literally given up on trying to figure out the whims of insurance and cannot guarantee you will be reimbursed as such. For your reference, the codes we usually provide with your super bill are provided below.
Please note: We can’t guarantee your insurance company will accept our super bills, diagnosis, or billing codes, and we do not play the insurance game to change their minds, fight denials, or support our clinical decisions. However, it’s usually not a problem with the vast majority of our patients enrolled with standard insurance programs.
New Patient Bundle:
99205 Medical Office Visit
99354 Medical Office Visit -extra time
97802 Office visit – Registered dietitian
Medical Office Visit to review lab (example of a 1.5 hours lab review appointment)
99215 Medical Office Visit
99354 Medical Office Visit -extra time
Follow up visit (example of a 30 min follow up in office appointment)
99214 Medical Office Visit
Follow up visit (example of a 30 min over the phone appointment)
99443 Medical Office Visit
Please note: This is for information purposes only as our codes and pricing may change without notice. For specific pricing information and the most current coding document please refer to the New Patient Process of the clinician, doctor, or program you wish to inquire about.
Scheduling your first appointment
We require a 50% deposit to schedule your individual or bundled appointments with our clinic. As long as you notify us at least 3 business days before your scheduled appointment, you are welcome to reschedule or the deposit will be fully refunded, as per your preference. However, if you cancel or reschedule your appointment within 3 business days of your appointment, with the exception of a “true emergency,” road closure, or some other extreme circumstance, your deposit will be forfeited.
Working with our clinic
Understanding how our clinic operates is imperative to our mutual success. Our protocols can sometimes be complex and require motivation on your part to implement. Our advice is to learn as much as you can during our early group patient education sessions and problem-solving visits and have confidence that, together, we will be successful. We are a project-based ‘Precision Medicine’ clinic, which means our team tackles imbalances and problems in a logical order, using genetic susceptibilities and diagnostics as our guide. The average patient works closely with us for 1 to 3 years.
Easy-Pay Programs for Testing
Many of the tests we use are cutting edge and novel, but they can also be costly if you don’t have any insurance. Our physicians use the best testing options at the lowest out-of-pocket expense available to our patients and we never mark up testing. We also use your insurance to the extent possible and specifically choose diagnostics that pose NO risk for costly insurance denials. When you qualify for an EASY PAY or PAY ASSURED program, and you pay upfront for testing, you will not pay additional fees for any reason. Regardless of deductibles, denials, et cetera, the all test are paid in full unless otherwise stated.
We have put in considerable effort to provide a large selection of novel functional and genetic testing options for our patients with the best pricing, insurance coverage and payment terms available.
Supplements & Products
Our nutritional pharmacy contains most of the nutraceuticals/supplements our physicians prescribe. Our private label products are high quality brands offered to patients below the MAP (Minimum Advertised Pricing) set by the manufacturer. Which is why we private label them in the first place. Whether you buy them from us or elsewhere is not important, but they should be the same brands we trust. However, we are confident that you will not legitimately find them for less elsewhere. Please beware of bait and switch small print, soon to expire, or mishandled products on the internet. Even blatant counterfeits of our suggested products exist online.
As with the use of other products, Natural Balance Wellness Medical Center will not supervise or take responsibility for products other than the ones we are familiar with and have tested and scrutinized carefully. Read our full disclosure
Supplements purchased from our clinic or online store are returnable within 30 days from the original date of purchase (with a receipt) provided there are at least 4 months until the printed expiration date. For safety reasons, we are unable to refund opened or temperature sensitive products (for example, refrigerated probiotics.)
Emailing our clinicians
In keeping with increasingly strict HIPAA regulations, we discourage clinical contact or clarifications via non-secured email directly with our doctors. However, you may email our patient care assistants to answer short and specific questions or clarifications.
Please note: For clinical concerns that cannot be quickly or simply answered, you will be asked to schedule a paid phone consultation with our doctor clinicians so they can review your chart and provide the highest quality care possible.
For specific pricing information and the most current coding documents please refer to the New Patient Process of the clinician or doctor you are working with.
Canceling OR Rescheduling
We recognize the value of your time. We hope that you recognize the value of our time too. In order to work closely with existing patients, we only offer a select number of new patient and follow up visits each month. We ask that you cancel or reschedule your appointment no later than 3 business days prior to your appointment. This way, we can use that time for another patient who needs it.
Therefore, please notify us 3 business days before canceling or re-scheduling appointments in order to avoid a full “cancellation/reschedule fee” equivalent to the visit missed billed automatically to your credit card on file.
Level 5/ lab review session, scheduled 60 minutes will be charged $450 for canceling or re-scheduling within 3 business days.
Level 5/ follow up visit, scheduled 60 minutes will be charged $370 for canceling or re-scheduling within 3 business days.
Level 2/ follow up visit, scheduled 20 minutes will be charged $140 for canceling or re-scheduling within 3 business days.
Please Note: This fee is assessed in order to cover the cost of the clinician and support employees specifically there to serve you. We do not overbook appointment and are not a high volume center able to absorb the cost of missed appointments.
Limitation of a small clinic
Please keep in mind that we are a small and very personalized clinic. While most patients understand this, some expect us to operate like a larger clinic or hospital; solve their insurance or legal concerns; and provide letters regarding their health or disability, time off from work, or other related concerns. While we recognize this is commonplace for doctors, our consistent experience has been that we are not able to address legal, disability, or insurance concerns. This does not mean we will not assist you in any way we can. We certainly will. We just know, based on experience, that our way of looking at your health concerns is very different than the “standard-of-care,” and we have generally found that we are not able to overturn insurance decisions or compete with conventional paradigms regarding your health or conditions.
Remember: our goal is to solve your complex health problems to the very best of our ability, and the true litmus test of our value should be whether or not we are helping you and/or your children feel better. To this end, we are confident you will be pleased with our approach and our results.
Welcome to our clinic!