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October 9, 2014

Revolution Health & Wellness Clinic’s goal is to provide you with the highest level of personalized care. We are committed to helping you achieve optimal health.

Revolution Health & Wellness Clinic has now merged with Transformation Health and is working towards accepting insurance. This means that we have more ways to better serve you.

Policies for Transformation Health:

Please understand that payment of your bill is considered your responsibility. We require all patients complete our forms before seeing Transformation Health providers.

Transformation Health is a partner organization with Revolution Health and Wellness Clinic. Revolution Health & Wellness Clinic’s policies apply to Transformation Health patients except in regards to insurance billing and payments. Transformation Health accepts most insurance plans while Revolution Health and Wellness Clinic does not.

Insurance (Other than Managed Care)

Your insurance policy is a contract between you and your insurance company. We are not a party to that contract. Payment is due at the time services are rendered. If your insurance has not been paid on your account within 45 days, you will be asked to pay for your services even though your insurance is pending.

Managed Care Insurance

We file for all office visits with PPO’s and HMO’s in which we participate. Copays are due at the time of service. If you do not have your insurance card with you at the time of your visit, you will be expected to pay for your visit at the time of service.

Medicare

Transformation Health participates in the Medicare program. We will file the claim with Medicare and will accept Medicare’s allowable payment. You will be billed for any coinsurance and deductible. If you have a secondary insurance, we will file your secondary insurance after the Medicare payment has been received.

Usual and Customary Fees

It is possible that any, or all, of your billed services may not be reimbursable by your insurance company. Discounted reimbursement by your insurance company (their arbitrary assignment of ‘reasonable and customary charges’, ‘medically necessary’, etc.) reflects an agreement by the policyholder and the insurance company. This in no way influences the charges or payment due to Revolution Health & Wellness Clinic for services rendered.

No Insurance Coverage

If you do not have insurance, your payment is due at the time of service.

Policies for Revolution Health & Wellness Clinic:

Website

Information about Revolution Health & Wellness Clinic is available at our website: www.RevolutionHealth.org

Medical Records

Medical records can only be released with your authorization. A Medical Records Release Form is available on the patient portal. You are responsible for obtaining previous medical records from other physicians or health care providers. Please contact your physician or other health care provider to obtain these records. Your records should be mailed to our clinic or brought with you to your appointment.

Consultations

Your initial visit will include a consultation with the doctor. We recommend that new patients schedule 30-60 minutes for their 1st and 2nd appointments. However, we will adjust this based on your budget and medical needs. Prices for appointments are based on the length of the appointment. Also, the length of your appointment is not necessarily the amount of time you will have with the provider.

Laboratory & diagnostic testing are integral components of your treatment plan. Test results are used to design your personal health care program as well as uncover the root causes of your medical condition. Nutritional supplements are often recommended and we will help you select and find the highest quality products.

We value your time and realize that there are times when face-to-face appointments cannot happen. Phone appointments are available for previously established patients and are charged based on the 15, 30, 45, and 60-minute appointment fee structures.

Initial Visits

You will need to be fasting for your initial visit. Many of the tests require an 8-hour fast. You can drink water during this fast. Costs of all testing will be reviewed with you by our staff after your medical consultation before labs are drawn. You will receive all final lab results and be guided through their interpretation at your follow up visits.

THE INITIAL VISIT will include a consultation. We recommend 45 minutes for this appointment.

Prolotherapy is not covered by insurance. There is an office visit fee for evaluation that will be applied to your procedure cost if you receive Prolotherapy during the same appointment. After your examination, you will be given your price for treatment. Payment is due at the time of service.

Some patients request sedation for treatment. Sedation appointments cannot be performed the same day as your consultation and incurs an additional fee. You must have a driver in order to receive any medications that may cause drowsiness.

Confirmation and Cancellation of Appointments

As a courtesy, you will receive appointment reminders via email 3 days before your appointment. You will receive a phone call reminder 3 days before your appointment.

Arrivals 10 minutes after your scheduled appointment time may be cancelled and rescheduled for the next available appointment time.

We have a 24-hour cancellation policy. Monday appointments must be cancelled by noon on the Friday before. When you make an appointment we are reserving time to spend with you on your health care concerns. This policy allows us time to reschedule another patient into your appointment time.

Cancellations of appointments within 24 hours will be charged 50% of the office visit fee to the credit card on file. If you do not show up to your appointment and do not cancel you will be billed for the full price of the visit to the credit card on file.

You may cancel your appointment by calling our office. If calling after hours, please leave a message.

Payment Options

Our office accepts cash, checks or credit cards (MasterCard, Visa, Discover) for services rendered.

When you schedule an initial visit, we require a credit card on file to hold the appointment for you. No charges will be applied to your credit card unless you miss or cancel an appointment without proper notice. On the day of your scheduled appointment, all charges for consultations and laboratory testing will be itemized and reviewed with you. Payment is due at the time of service.

Follow-up phone consultations will be billed to your credit card on file unless you provide other payment information and instructions prior to your appointment. If additional lab tests are required and our office sends test kits, the appropriate fees will be charged to your account.

Insurance Information

Revolution Health & Wellness Clinic does not accept insurance and we do not accept payment from your insurance company.

Transformation Health DOES accept most insurance plans (see above).

If your insurance plan pays for services at Revolution Health and Wellness Clinic you may file for reimbursement from your insurance company. We will be happy to provide you with the correct forms and codes that you will need.

Note: Unfortunately, our staff will not be able to contact your insurance company for the purpose of ‘problem solving’. If your insurance company requires treatment records, you may obtain these through your patient portal.

It is possible that any, or all, of your billed services may not be reimbursable by your insurance company. Discounted reimbursement by your insurance company (their arbitrary assignment of ‘reasonable and customary charges’, ‘medically necessary’, etc.) reflects an agreement by the policyholder and the insurance company. This in no way influences the charges or payment due to Revolution Health & Wellness Clinic for services rendered.

Specific therapy or outcomes are neither expressed nor implied.

BlueCross/BlueShield: BlueCross/Blueshield often sends payment for services rendered directly to the patient. If you do get a check from your insurance company then you will likely receive a bill from the lab for the exact amount of money you were paid. However, in most cases, you will not have to pay anything out of pocket. We suggest that you set this money aside in anticipation of the bill. If you have any questions or concerns please let us know and we will help you as much as possible.

Medicare/Medicaid: Revolution Health & Wellness Clinic is opted out with Medicare and SoonerCare (Medicaid). We do not bill these nor can you submit claims on your own. However, your labs are generally covered under Medicare. Any additional charges for labs will be discussed with you prior to obtaining them. Charges are due at the time of service.

HMO: HMO policies will not accept billing from Revolution Health & Wellness. However, insurance will be filed by the lab (independent of Revolution Health & Wellness Clinic) if you choose. Any additional charges for labs will be discussed with you prior to obtaining them. Charges are due at the time of service.

Phone Calls, Messages & Faxes

  1. To reach Revolution Health & Wellness Clinic, please call (918) 935-3636.
  2. If you call after hours, our office staff will return your call on the next business day.
  3. If you have a medical emergency, call 911 or go directly to the nearest emergency room.
  4. When leaving a message, please be brief and include the following information:
    1. Full name
    2. Reason for call
    3. Best time to be called back
    4. Phone number(s)
    5. Email address (if desired)

Prescription Refill Request

While we do the best we can to ensure the highest quality medical care, it may take up to 72 hours to process a prescription refill. Please plan ahead to avoid any interruption in your medications. Prescription refills can be faxed to our office by your pharmacy.

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