Payment Policies and Insurance

PAYMENT POLICIES
We try to make payment as painless as possible. Please remember that the ultimate responsibility for payment is with you, the patient. We request payment at the time of the visit or the transfer of products.

Special financial arrangements can be made upon request. Here is a sliding scale:

Annual personal or family income:
Commensurate treatment fee for Initial visit & Continuing visits:
Over $40,000 - $80 initial visit, $60 per continuing visit
$20,000 to $30,000 - $70 initial, $50 continuing
$10,000 to 20,000 - $65 initial, $45 continuing
Under $10,000 - $60 initial, $40 continuing

Simply ask.

INSURANCE
We are all set to bill your insurance company directly as a service to you. If you would like us to bill your insurance, you need to:
• Complete the insurance questionnaire, with a positive verification of coverage.
• Sign the assignment of benefits and release of information on two red claim forms
• Pay for your visits until you meet your deductible, if applicable.
• Pay your portion of the bill (co-payment) at the time of each treatment.
• Inform us of any change in your coverage.

We will also be more than happy to provide you with a receipt which will enable you to be reimbursed directly by your insurance company.

(707) 456 - 9514
dancemolley@pacific.net