аЯрЁБс>ўџ ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ§џџџўџџџ  ўџџџўџџџ !"#$%&'()*+,-./01234567ўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot EntryџџџџџџџџВZЄ žбЄРOЙ2Кp5ЗЮЦ8CONTENTSџџџџ *Object 1џџџџYлс§nчLŒ -ЃМЊйЦ3ђЖЮЦ3ђЖЮЦContentsџџџџџџџџџџџџ<<ўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ applied to your deductible or paid. West Valley Naturopathic Center shall in turn write a check to the patient for the portion of the visit that was covered by your insurance provider which can be verified on your EOB. If you have any further questions please feel free to contact our insurance biller. By signing below you agree to the above terms and conditions and that you will follow up with our office in the event that your insurance provider has not responded to the claim in 30 days. ____________________________________ Patient s Signature/Date een reached, however, we cannot guarantee this for any plan, nor will your insurance provider. It is your responsibility to contact your insurance provider to determine what your deductible is and how XМОPRфц‚ „ npКМdfцшъь6hjlќќєєєќќќќќќќќќќќќќќќќќќЬЬ(2‚"'(Š  л) @ЗS XМО@NђаоfhlъиТИЊ˜ˆvˆvˆvˆЊИ "PS"  "PS"  "Р" "  "  "0р"  "0р"  "0р"  œх*џџџџœх* "№ "ttll(ЄхXTimes New Roman!џ4 "ЭH".й""џ4  " " "ЄјУьШXXK*KGаHP Officejet 7300 series!@œhп€ъ od§џBƒe‡RLdџџџџhpqpprop€dрррHBƒe‡ЬкКCHNKWKS *јџџџџTEXTTEXTlFDPPFDPPFDPCFDPCSTSHSTSHSTSHSTSH2SYIDSYIDPSGP SGP dINK INK hBTEPPLC lBTECPLC „FONTFONTœ<EOBJPLC и4STRSPLC :PRNTWNPRF FRAMFRAMF'ˆTITLTITLЮ'8DOP DOP ( If you have any further questions ќџ West Valley Naturopathic Center_________ Time to listen, Time to Care, Time to Heal Insurance Billing Office Policies 1.) We will as a courtesy to our patients, bill any PPO insurance plan. Your plan should reimburse for office visits at West Valley Naturopathic Center once your deductible has been reached, however, we cannot guarantee this for any plan, nor will your insurance provider. It is your responsibility to contact your insurance provider to determine what your deductible is and how much of your deductible has been met. 2.) If you have our office bill your insurance on your behalf you agree to follow up with your insurance provider in 30 days from the time of your office visit if they have not either accepted or denied your claim. This will allow our office to follow up with your insurance provider to ensure that your claim gets processed. 3.) Upon your initial visit you will be asked to complete the highlighted portions of a health claim form which will be kept in your chart to help our staff to facilitate insurance billing on your behalf. 4.) Payment shall be made in full at the time of the visit, unless, we are in-network with you insurance provider. Currently, Lifewise is the only insurance provider that we are contracted in-network. For these individuals we will accept your co-pay, and you will be responsible for payment to West Valley Naturopathic Center for any remainder of the bill that was not covered by Lifewise. For any service that is not covered by Lifewise we shall again take full payment at the time of the visit. Your insurance provider should respond to the filed claim within 30 days with an EOB (explanation of benefits), that will inform you if your claim has been either: accepted, denied, why it was denied,ЬкКHP Officejet 7300 series7300 series,LocalOnly,DrvConvertбVWK*ьШXX*winspoolHP Officejet 7300 seriesUSB001Fџџ"\В"€‘"бV"$c"№` "№`""A."@џџ"\В"№љ"бV"$c"№` "№`"."Insurance Office Policy.wps"иp"иp (" to facilitate insurance billing on your behalf. 4.) Payment shall be made in full at the time of the visit, unless, we are in-network with you insurance provider. Currently, Lifewise is the only insurance provider that we are contracted CompObjџџџџџџџџџџџџVSPELLINGџџџџџџџџџџџџhџџџџџџџџџџџџџџџџџџџџџџџџ96ttNN<lMM Ж EMF<T 0АFGDIC€ШЪЭј ќR  NN &_FMRIB? & _FMRCG(&+ "&9_FMRSP X! 'EF9"57:L169R!",N4#(BE'(9979S!"4I=6=E1'K&Œ_FMRFSQ P0 H#