Financial Policy

paymentsMyo Therapies LLC
Financial Policy

Providing the best care for you is our top priority. To avoid misunderstandings that can negatively impact our services toward you, we are pleased to provide you with a statement of our financial policies. Your clear understanding of this policy is important to our professional relationship. We would be pleased to discuss our fees with you at any time.

( ) Appointments / Cancellations / No Show / Late Arrival / Terminated Sessions
Your appointment time is a time we set aside just for you. All cancellations require a 30 hour advanced notice. There will be a $40 cancellation fee charged to those that do not cancel within this period prior to a scheduled appointment. Insurance companies and Labor and Industries will not pay for missed appointments, therefore; you will be billed directly. They are your responsibility and will be due and payable upon billing.
If you are late, you are still required to pay for the full amount of time scheduled. No additional time will be added to the scheduled time. If you are more than 15 minutes late you may be regarded as a “No Show “ and it will be up to the discretion of the therapist as to whether or not to continue the appointment.
If a session needs to be terminated early (due to improprieties, or for reasons not in our control), you are still responsible for the complete scheduled appointment time.

( ) Automobile Accident (Personal Injury Insurance, PIP) Claims
If you were involved in a motor vehicle accident, please provide us with a prescription from your attending physician and a claim number issued by your insurance company. We will bill your insurance, if you were not at fault they will be reimbursed by the other driver’s insurance upon settlement. If you do not have PIP on your insurance policy, we strongly suggest that you seek legal advice. If your insurance denies payment for any reason that cannot be rectified by our office or the attending physician, your account balance will be due and payable upon notice of denial. You are responsible for all unpaid services. Third party insurance will be considered on a case by case basis only.

( ) Medical Massage & Labor and Industries (L&I) Claims
If you were injured and were referred to our office for massage therapy by your attending physician, we require that a prescription from your doctor be provided. Our office will complete all billing paperwork and mail it to the insurance company. Please provide us with the information regarding your insurance coverage and or claim representative. If they deny your claim or refuse to pay for our services for any reason that cannot be rectified by our office or your attending physician, your account balance will be due and payable upon notice of denial. You are responsible for all unpaid services.

We emphasize that as health care providers, our relationship is with you and not your insurance company. Filing insurance claims is a courtesy to our clients. Please understand that your insurance is a contract between you and your insurance company. We are not a party to that contract. All charges therefore are your responsibility from the date the services are rendered.

( ) Gift Certificates
Gift certificates are redeemable for one year from date of purchase. The above policy concerning appointments and cancellations applies. Rather than being billed for the session, the gift certificate will be considered as having been used. Gift certificates are not redeemable for cash.

( ) Payment and Finance Charges
Payment is due at time of service unless prior arrangement is made. Myo Therapies accepts cash, check or Visa/Mastercard. All past due accounts are subject to a 21% annual percentage rate, compounding monthly. A $35 fee will be added for checks that are returned.
Client (Legal Guardian) Signature:__________________________________________Date:_______

Authorization to bill insurance on my behalf:__________________________________Date:_______

©2013 Myo Therapies LLC