Client Fees and Payment Policies of Emerald City Naturopathic Clinic, Inc., P.S.

We plan for your experience at Emerald City Naturopathic Clinic to be an excellent one. To further that goal, we want you to be fully informed about our fees and payment policies. The following information pertains to our cash-only practitioners. Full payment for all charges is required at the time of service. In special circumstances, the doctor may arrange differently. All practitioners at Emerald City Naturopathic Clinic can bill PIP accident claims and L&I claims. See section #9 below for payment policies in these cases. If you have other insurance coverage and you wish to submit a bill to request reimbursement for services received here, please ask for a superbill from the front desk during your checkout. These can also be provided for you at a later date at a charge of $3.00 each. We accept payment by check, cash, MasterCard, or Visa. Checks or credit card payments that are denied for lack of funds will incur a fee of $40.00. A minimum billing fee of $2.00 or 15% APR, whichever is greater, is added to any unpaid balance each month it is past due. Slight fee increases occur in October of each year to accommodate increases in expenses. We are committed to providing quality health care. Thank you for selecting ECN for your health needs.

1. First Office Call: $418. This is generally for an extended visit. Fee scale applies also to first visits by phone. Phone charges and time spent in addition to the phone visit for sending supplies or paperwork will be additional. ***Dr. Molly Niedermeyer only accepts new clients with a professional referral and cost is $508 for her initial visit. All other Emerald City Clinic physicians are accepting new patients at the above listed rate.***

2. Return Office Call: Cost is Variable, starting at $298 for Dr. Niedermeyer and $268 for Dr. Kozowski. Visits that extend past 30 minutes will be charged for an extended office call.

3. Extended Return Office Call: Cost is Variable: $358.00 minimum charge.

4. Extended Return Office Call with Dr. Niedermeyer: $398.00 minimum charge.

5. Phone/ Email Consultations: Variable: $88 minimum charge. Medical Insurance, PIP and L&I do not cover this expense- this fee is your responsibility. Phone or email consultations are provided for established clients only under special circumstances determined by the physician. The minimum fee is charged for any phone consultation up to 15 minutes and for email responses where a single reply suffices. Phone consultations that extend beyond 15 minutes will incur a greater charge. Email consultations that require multiple communications will incur additional charges. We strongly suggest phone consultations occur while you are at home - not while you are driving in your car. This fee is not charged in the following cases: when you require clarification of on-going therapy and when the doctor has asked you to call. If there is any question about this service you are welcome to ask in your call or your email inquiry. The physician will respond to your inquiry within 24 hours; however, due to unexpected medical emergencies a response is sometimes delayed. If the doctor has not responded within 24 hours, please call or email the doctor again.

6. Emergency Pager: $138. In cases of medical emergency, the doctor is available 24 hours a day by emergency pager.

7. Physical Medicine Services: Steam Shower, Infra-Red Sauna, Constitutional Hydrotherapy, Electrical Stimulation, Ultrasound $38/15 min Manual Therapy, Visceral Manipulation, Craniosacral Therapy $59/15 min

8. Cancellation Charge: We require 24 hours notice received during our normal business hours for canceled or rescheduled visits, or a charge will be billed to you. Dr. Niedermeyer requires a 72 hour cancellation or the full cost of the appointment is charged. PIP and L&I insurance does not cover this charge; it is your responsibility. There is no charge for visits canceled with 24 hours notice. Half the cost of the scheduled visit will be charged for cancellations with less than 24 hours notice. Full fee is charged if no notice is received.

9. Insurance: We no longer accept any insurance. We are happy to provide you with an itemized receipt or superbill which you can submit to your insurance for potential reimbursment.

10. Purchase & Return of Pharmacy Items/ Products: All pharmacy items must be paid for at the time of purchase. Credit on account will be given for unopened items in perfect condition if returned within 30 days.

    After 30 days, the pharmacy item can be returned with a 15% re-shelving fee if unexpired. Expired products can be donated to the clinic, but no credit will be given. Injectibles, injection supplies, products packaged in the clinic, and birth control devices cannot be returned.

11. Mailing of Pharmacy Items: We will mail you items for which you have pre-paid, including a handling fee of $8.00 plus postage. Unfortunately, we cannot be responsible for your reception of these items. No refund can be made, or unpaid replacement sent, if the items fail to reach you. Mailings can take up to a week to send out, so please plan ahead. In addition, we now offer an online pharmacy option through Full Script with free shipping over $49 and automatic reminders when you need refills. Please email your physician to see if this option is right for you

12. Interest Fee: If, for any reason, payment in full is not received at the time of service, a finance charge / billing fee of $2.00 will be charged. This charge will accrue each month until the patient no longer carries a past due balance. If a phone, email consultation, or pager fee was not paid at the time of service, there will be no interest if balance is paid prior to 30 days. Pre-arranged payment plans will accrue finance charge / billing fees on unpaid balances.