Financial Policy and Agreement
Avana Health LLC’s commitment to serving our patients includes a clear statement of our financial policy. If any policies mentioned in this Financial Policy are unclear, the patient and/or guarantor may feel free to contact us and request further information. Our contact information is at the end of this Financial Policy and is available on our website at www.avanahealth.org. In this policy, Avana Health LLC may be referred to as “us”, “we”, or “Avana Health” and Ashok Kannan, DO may be referred to as “the physician” or “the owner”.
Providing Us With Demographic, Identification, and Insurance Information
By signing this agreement, the patient and/or guarantor agree to always present up-to-date identification, insurance card(s), insurance information (including primary and supplementary insurance plans, automobile insurance plans for automobile accidents, workers’ compensation information, if applicable, liability insurance information, if applicable, and other types of insurance information), and demographic information when asked by us.
Making Payments
In signing this agreement, the patient and/or guarantor agree to make on-time payments, such as paying any copay and/or deductible amounts, by the due date agreed upon by the physician and the patient and/or guarantor.
If an outstanding balance is due, for example an amount that your insurance company deems as your responsibility, which sometimes occurs days to weeks after a visit, then we may call you and ask to pay that amount by sending a digital invoice. You may be asked to pay the balance at that time or at another time as allowed by the owner.
Outstanding balances that are not paid for more than 90 days may be forwarded to a collection agency for collection.
Patients and/or guarantors agree to provide payments by major debit or credit card (ask us about credit cards we accept), Google Pay, Apple Pay, check, or ACH transfer. Cash will not be accepted.
Payment plans will not be available through Avana Health LLC.
Nonpayment is reason enough for dismissal from our care.
Referral Status
The patient and/or guarantor agree to provide us with any referral documents from other providers.
Insurance Coverage
Know the patient’s insurance coverage limits and policies and know the patient’s responsibilities and abide by them. It is the responsibility of the patient and/or guarantor to know their benefits, including, but not limited to, if our services are considered in-network or out-of-network and if a referral is needed to receive services from us.
We will do our best by helping to facilitate your communication with your insurance, if necessary, and verifying your status with the insurance company.
The patient and/or guarantor will be responsible for on-time payments of any fees for which they are deemed responsible
For services rendered by entities other than Avana Health LLC, the patient and/or guarantor is responsible for knowing (or finding out, if they do not know) which entities are most and least covered by their insurance plan. This includes imaging/radiology centers, laboratory services, surgery centers, physical/occupational/speech and swallow therapy entities, hospitals and rehabilitation centers.
If Avana Health LLC provides a service that the patient’s insurance provider(s) will not cover, Avana Health LLC, if appropriate, will bill the patient and/or guarantor for the service or portion of the service that was not covered by the insurance provider. Unless the insurance provider indicates that the patient is not responsible for the service, the patient and/or guarantor will be responsible for the service.
If workers’ compensation or accident coverage is to be used as coverage for our services, it is the patient’s responsibility to provide us with any information related to the claim.
Billable Visits
All services, including in-person visits, video calls, phone calls, and electronic correspondence may be billed/charged to the patient and/or guarantor and/or the patient’s insurance provider. This includes services not scheduled ahead of time. Signing, by the patient, patient’s legal representative, and/or guarantor, of this policy and agreement serves as written consent that in-person visits and telehealth visits, including video calls and phone calls, will be billed/charged to the patient’s insurance provider and/or patient and/or guarantor from today onward until the patient, patient’s legal representative, and/or guarantor gives notice to Avana Health LLC for this consent to be revoked, which may be done verbally or in written form at any time.
Other Fees
Checks are accepted. There will be a $20.00 fee assessed and billed to the patient and/or guarantor for any checks that bounce (returned checks).
Insurance Companies that Avana Health LLC is Currently Contracted With
There are several insurance companies that we are contracted with. This does not mean we are necessarily in-network or out-of-network with any plan. The patient and/or guarantor is responsible for knowing this or contacting their insurance company to find out. This is a list of companies that we are contracted with and/or currently pending contract completion with: Medicare, Medicaid, HMSA, Aetna, United Healthcare, Cigna, Humana, UHA, ‘Ohana and Wellcare by ‘Ohana, Veterans Affairs, Tricare.
If we are considered out-of-network for a certain plan, the patient and/or guarantor should be prepared to cover the full cost of the visit. The insurance provider may still cover a portion, and we will try to help the patient determine this by trying to confirm this information before the visit and by submitting the claim, if allowed, to the insurance company on the patient’s behalf.
Our Guarantees
Avana Health LLC will not charge the patient and/or guarantor a fee for filing a claim for payment to any insurance company/payer. Avana Health LLC will abide by insurance/payer contractual policies when collecting fees from responsible parties.
Refunds
Refunds will be rendered within 15 days from the date that any overpayments are assessed.
Authorization for Insurance Companies to Pay Avana Health LLC
The patient and/or guarantor and/or insured and/or authorized person agrees to indicate whether or not they authorize payment to be made on the patient and/or guarantor’s behalf to Avana Health LLC for any services provided to the patient. In lieu of indicating authorization for each claim separately, the patient and/or guarantor agrees, by reading this policy and signing this agreement, that the patient and/or guarantor authorizes payment to be made from the patient’s insurance provider to Avana Health LLC on behalf of the patient and/or guarantor for all future services provided and claims furnished unless the patient and/or guarantor indicates otherwise. The patient and/or guarantor agrees that, by signing this agreement, their signature will be held on file as proof that the patient and/or guarantor and/or legal representative allows Avana Health LLC to file claims to the patient’s insurance provider, government or commercial, for all services provided to the patient and for their insurance provider to pay Avana Health LLC for all services rendered to the patient until they or Avana Health LLC indicates otherwise. This includes payment to the patient/guarantor/legal representative or directly to the provider accepting assignment. The patient and/or guarantor also understands that, by signing this agreement, they authorize the release of medical information necessary for assessment and payment of any claims filed to primary and supplementary insurance providers, government or commercial. The patient/guarantor/legal representative also authorizes crossovers from primary to secondary/supplementary insurance providers to facilitate the claims processing and payment process.