Thank you for choosing Three Moons Acupuncture as your healthcare provider. We are committed to your treatment being successful. Please understand that payment of your bill is considered part of your treatment. The following is a statement of our financial policy, which we require you to read prior to any treatment.
Our fees are determined by the complexity of each case and different services used.
We will verify coverage prior to treatment and we will file all claims as a courtesy to you. If for any reason we are not able to verify coverage prior to your treatment, you will be charged for the treatment until verification is obtained. We cannot bill your insurance unless you bring us all necessary insurance information. We are not a party to that contract. By signing this document, you are assigning to this office the benefits to which you are eligible to receive for care rendered in this office. Additionally, in signing this document you authorize the release of any information to any insurance company, adjuster or attorney that will assist in the payment of a claim. We request a credit card on file if the insurance company should not pay claims or any balances owed should there be any difference in the amount owed.
Usual and Customary Rates UCR:
Our practice is committed to providing the best treatment possible for our patients. We charge what is usual and customary for our area. Please be aware that some and at times perhaps all of the services may be non-covered services and not considered reasonable and necessary by medical insurance. All payments are due at the time of service. We accept cash and all major credit cards FSA and HSA. We DO NOT accept checks.
CANCELLATION & RESCHEDULING POLICY
Your appointment time is reserved specifically for you. If you need to cancel or reschedule your appointment, please do so at least 24 hours before your scheduled appointment time. Changes can be made online using the link in your confirmation email, or by calling us at 262-977-8793.
All appointments (including new patient appointments) that are cancelled or rescheduled with less than 24 hours advance notice will be charged 50% of the regular appointment fee to the card on file. This includes appointments that are made as part of a package.
Unless cancelled at least 24 hours in advance, our policy is to charge for missed appointment at the rate of a normal office visit if you are a repeat offender of this rule. Your treatments will be more effective if you follow your treatment guidelines and adhere to your schedule. Please help us to serve you better by keeping your scheduled appointments. Please let us know if you have any questions or concerns.
If you are 15 minutes late to your scheduled appointment, you will not be treated that day and your appointment must be rescheduled.
A no call / no show: will result in a charge for the missed appointment at the rate of normal service charge.
A no call / no show charge must be paid before another appointment will be scheduled or administered.
After 3 no call / no show’s: the patient may be terminated.
Appointments are considered cancelled and forfeited 20 minutes after the appointment time
without advance notice and charged to the card on file per the policy. Please contact us at
262-977-8793 if you are running late.
Emergencies and certain exceptions can be made on a case by case basis but must be done by phone before the appointment.
We value your business and we enjoy being a part of helping you stay healthy and happy.