FEES FOR COMPLETION OF FORMS

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

• Patient Information and Member information Sections be completed by the patient in conjunction with the Wellness Pharmacy Care coordinator. The doctor is not responsible for the completion of these sections. 

• This fee includes:

  • The doctor's time to complete the physician sections of your insurance forms AND

  • ONE revision for missing/clarification of information in the forms that your insurance provider may request from you.

  • Pharmacare Special Authority may be required for certain insurance plans. If your coverage is declined because of this, the doctor will complete it at no charge once informed.   

• Payment must be received prior to forms being completed and sent back to the Patient Care Coordinator at Wellness Pharmacy. 

 

• PLEASE NOTE:

  • 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.

  • The fee is non-refundable and is NOT contingent on approval.

  • If there is missing or inaccurate information in the Patient/Member Information Sections:​

    • It is the patient's responsibility to be forthcoming in addressing gaps with the patient coordinator by returning calls and emails promptly to avoid delays in approval.

    • Failure to secure coverage due to missing or inaccurate information in these sections is not the physician's responsibility.

  • We advise against treatment prior to insurance approval; however, if you elect to proceed with treatment before securing insurance coverage, the physician is not liable.

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INSURANCE FORMS WHICH REQUIRE RECORDS TO BE RELEASED

• In addition to fees to complete paperwork 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

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PROCESS ONCE INSURANCE FORMS ARE COMPLETED

Once your payment has been received.

• A copy of the completed insurance forms can be provided to you upon request. 

• 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 the 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 $275 and is 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 fee does not cover the doctor’s assistance to appeal.

• Extra charges based on the doctor's time will be billed at $150 per 15 minutes, plus tax.

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Prior to the start of the process, please reach out to the office if you have any issues regarding affordability

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