FEES FOR COMPLETION OF FORMS

• The fee to complete insurance forms is $150 plus tax for each form completed.

• This fee includes the doctors time to fill out the forms and for ONE revision for missing/clarification of information in the forms that your insurance provider may request from you. 

• Payment must be received prior to forms being sent.  

• Completion of the forms DOES NOT imply approval for the medication.

• Coverage is typically based on the provisions of your extended health care plan and qualification criteria.  

• Please note the fee is non-refundable and is NOT contingent on approval

INSURANCE FORMS WHICH REQUIRE RECORDS TO BE RELEASED

• In addition to fees to complete paper work there will be additional fees for review of records and photocopying

  • The fee for the physician to review records is $117.00 per 15 minutes

  • The fee for photocopying records is $2.10 per page for the first 10 pages and then $0,30 per page for each page over 10

PROCESS ONCE INSURANCE FORMS ARE COMPLETED

Once your payment has been received.

• A copy of the completed insurance forms will be emailed to you which you will then need to submit to your insurance company.  

• As a courtesy the forms will also be faxed to your insurance company.

• However, we strongly recommend that you ALSO mail, fax or upload the forms to your insurance company yourself to avoid issues.   

  • It is your responsibility to ensure forms have been received by your insurance company. 

  • If you do not hear back regarding a coverage decision, please contact your insurance company directly to inquire.   
     

Your fee will not be refunded if there are issues with your insurance company covering the medication or receiving the fax.  

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 PROCESS FOR INSURANCE DECISIONS

The insurance company does not inform our office regarding coverage decisions due to privacy regulations and laws.  

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• If the forms have been declined for missing information or there is a request for more information you must inform our office what to revise and ideally provide us a copy of the letter the insurance company has provided you regarding reason for declining.  

• The office is not responsible for coverage delays if this information is not provided to us.  

 

INSURANCE DECISION OF APPROVAL

• If you receive approval, you must contact our office to arrange for a prescription  

• If the medication needs to be administered by the doctor you will need to arrange for an appointment time with the MOA.  

• For Botox we deal with wellness pharmacy and typically there are 1-2 days per month reserved for Botox injections.

• The fee for the MD to inject Botox starts at $250 if not an MSP covered benefit.

  • Examples of MSP injection fee covered benefits are cervical dystonia, blepharospasm and spasticity to name a few.

  • For non MSP covered benefits this fee is independent of the cost of the medication and is a fee to administer/inject and prepare the medication.  This is a standard practice industry wide.

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INSURANCE FORMS THAT ARE DECLINED

• If you have been declined  the original feel does not cover the the doctor’s assistance to appeal.

• Extra charges based on time spent by the doctor will be billed at $150/per 15 minutes plus tax.