Gonstead Clinic of Chiropractic
1505 Bus. Hwy. 18-151 East, Mt. Horeb, WI 53572
phone: (608) 437-5585 · fax: (608) 437-7041

FEES & FINANCIAL INFO

Fees & Financial Policy
Our fees are determined by the value we place on the services rendered, the cost involved in delivering that service and by what is considered reasonable and customary in our community. If you have any questions, please do not hesitate to discuss our fees with us. We are always willing to explain the different options for treatment of a particular problem and the advantages and disadvantages of each.

Payment is requested from all of our patients at the time the service is rendered. Patients with health insurance are allowed to pay their deductible, co-insurance and remaining balance that is their responsibility at each visit.

It is our firm office policy that all services rendered in this office are charged directly to you, the patient. You are personally and fully responsible for all payments regardless of whether or not we accept insurance assignment. Insurance is an agreement between you and your insurance company. All questions regarding coverage should be directed to your insurance company or benefit administrator. We will continue to submit claims as an added service to our patients.

Patient balances are required to remain below $150.00. we realize there may be special circumstances and periodic difficulties with finances. If special needs do arise our accounts manager would be happy to discuss special financing involving your specific treatment plan.

For your convenience we accept payment by MasterCard/Visa, Discover, personal check, or cash. Receipts will be given when requested.

We sincerely appreciate the trust you have placed in us and we will always do our best to provide you with individualized, quality care. We feel good communication is essential in a good and lasting relationship with our patients.

Insurance, Worker's Compensation & Personal Injury Claims
As a courtesy to our patients, we will complete and file an insurance claim for each visit (providing we have your correct insurance information and a signature on file). Please feel free to discuss your coverage with us. Health insurance is an agreement between you and your insurance company. Therefore, we consider our patients personally responsible for all charges generated in our office.

Workers Compensation (WC) Claims
Patient must inform us prior to treatment that this is a WC claim. Employer information and authorization is required prior to treatment. Our insurance specialist will submit WC claims directly to the WC insurance unless other arrangements have been made.

Personal Injury (PI) Cases
Patients must inform us prior to treatment that this is a PI case. Necessary insurance information must be on file prior to treatment. Our insurance specialist will submit PI claims directly to the patients insurance company. It then is the responsibility of your insurance company to determine responsible party/parties for submission and payment.

Our policy allows your insurance company 60 days to remit payment. In the event your insurance fails to pay within 60 days or if there is a dispute over a claim, the balance of the claim(s) would come due. Any over-payments will be refunded.

Now Accepting Dean Insurance!