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
   

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.   

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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.