Financial Policy

Financial Policy & Procedures

This notice outlines the financial policies and procedures of The Back Alley Chiropractic & Massage. Please review it carefully. Contact our office with any questions (520) 877-2666. Financial Policy updated 10/9/2025

Financial Policy

Balances Due Unpaid balances are past due at 30 days. Balances left unpaid may receive a second and third notice prior to final notice, mailed at 30-day intervals. The Back Alley Chiropractic utilizes an outside collection agency to collect balances over 120 days past due.

Fee Schedule Our current fee schedule is attached and can also be found on our website at any time. Fee schedules are regularly updated.

Insured As a courtesy to our patients, we will submit your in-network medical claim to your insurance carrier. Patient responsibility is due at time of service. Patient balances are billed immediately upon receipt of your insurance carriers Explanation of Benefits (EOB), and your remittance is due immediately upon receipt of our bill. We do not bill out-of-network claims. We do not bill secondary claims.

Medicaid/AHCCCS Effective October 1, 2022, the state of Arizona made additions and changes to Chiropractic coverage for Medicaid/AHCCCS recipients as follows: AHCCCS will cover up to 20 medically necessary chiropractic visits for adults each year. Services must be ordered by a primary care provider and within the scope of chiropractic practice as defined by state law. If you actively qualify for AHCCCS, a referral from your primary care provider (PCP) will be required before scheduling any appointments, regardless of patient status. According to Arizona state law, a provider with an AHCCCS contract is required to bill AHCCCS for any covered service(s). In addition, Arizona state law does not allow AHCCCS recipients to opt-out of using their coverage at a provider’s office for covered services.

Medicare We are a participating Medicare provider accepting Medicare assignment. As a Medicare patient you are responsible for your deductible and co-insurance. If you have secondary or supplemental insurance, you must insure you have signed up for Medicare crossover in order for the full claim to be covered by both carriers. Our office does not bill supplementary or secondary carriers. Medicare non-covered services are due at the time of service. According to federal law, unlike other medical providers, Chiropractors cannot opt-out of the Medicare program, therefore, Medicare beneficiaries cannot opt-out of using their coverage in our office.

Medicare Advantage Medicare Advantage is an alternative to traditional Medicare. Plans operate under the same rules as traditional Medicare, but coverage is provided through a commercial insurance carrier, and your Medicare Part B benefits no longer apply. Some plans may offer additional benefits that are not included under traditional Medicare, however many services rendered in a chiropractor’s office continue to be non-covered and are due at the time of service.

Payment We accept cash, personal check, debit, and Visa, MasterCard and Discover. If you forget your form of payment, we may require you to reschedule. A surcharge of 3% is imposed on all brands of credit card transactions, that is not greater than our cost of acceptance. There is a minimum fee of $40 charged for returned checks.

Personal Injury Claims We bill third party insurance carriers only on a lien basis. Please notify our staff of your personal injury immediately. You will be asked to complete forms specific to personal injury as well as a consent and notice for medical lien. By consenting to Medical Lien, you elect not to use any coverage potentially available under a health insurance or similar medical benefit plan that may cover you, the injured, as an insured or dependent. By consenting to Medical Lien, you elect to opt-out of any Prompt Pay discount available to you and payable at the time of service for each date of service.

Prompt Pay We offer a Prompt Pay discount for all patients by request. If you fail to provide payment at the time services are rendered, you will be responsible for and billed 100% of the professional fee. A copy of our fee schedule can be found on our website at any time. You may also request a copy at the front desk. Insurance cannot be used when opting for a Prompt Pay discount.

Self-Pay We offer affordable self-pay rates to all patients under the Prompt Pay discount, with the requirement that payment be made at the time service is rendered. If you are insured and elect to self-pay you will be required to sign a separate form electing to opt-out of utilizing potential coverage. If you are self-pay and fail to provide payment at the time service is rendered, you will be responsible for and billed 100% of the professional fee. Medicaid/AHCCCS members cannot elect to self-pay. Medicare Beneficiaries cannot elect to self-pay.

Workers Compensation If you are here because of a work related injury, please be aware that very specific paperwork is necessary to ensure your treatment is covered under your employer’s plan. If you have completed a report of injury with your employer, retain a copy for your records, we will require this at your first visit. Many worker’s compensation insurance carriers require authorization or referral for chiropractic treatment, which must be received in our office before scheduling your initial appointment.

Insurance Policy & Procedures

• Many insurance companies have defaulted to utilizing “electronic” ID cards and are no longer sending paper or plastic copies in the mail. While this has become standard practice, The Back Alley Chiropractic’s contract with your insurance company still requires that we obtain a copy of your insurance card and identification card for each visit. Our standing policy to comply with these requirements is to scan your insurance card(s) and identification card at your initial visit, and a minimum of once a year thereafter. Electronic ID cards should be emailed to thebackalleychiro@yahoo.com.
• The Back Alley Chiropractic fully complies with all our insurance contracts. It is not our custom to balance bill amounts not allowed by your insurance policy. It is your responsibility to update us with your current insurance information. If you fail to notify us of a change in carrier, termination of coverage, and/or exceeded benefits, you will be 100% responsible for payment per your insurance policy’s allowable amount.
• The Back Alley Chiropractic strives to contract with local insurance plans, however due to special cases this may not be possible. If we are not contracted with your plan, we are not under any legal obligations to submit a claim. In the interest of keeping costs as low as possible for all parties, we will not submit claims for out-of-network benefits. If you opt to seek reimbursement directly from your plan, we will be happy to provide an itemized statement at your request.
• Chiropractic care is designated as specialty care under many insurance plans. It is your responsibility to know if a referral or pre-authorization is required to see specialists. If a referral is required, it is up to you to arrange the submission per your insurance carrier by your primary care provider (PCP).If a referral or authorization is not received prior to your appointment, your appointment will be cancelled or rescheduled until services have been properly authorized.
• The Back Alley Chiropractic does its best to verify and interpret your benefits and eligibility specific to chiropractic and therapeutic procedures. Occasionally we are given incorrect information by human beings. As human beings ourselves, we too can make mistakes. In any case, you are responsible for balances owed if your Explanation of Benefits (EOB) shows a different amount owed from your verification. Any questions about balances owed should be directed to your insurance carrier’s member services, which can be found on the back of your insurance card or on your EOB.
• According to your insurance carrier, you are responsible for co-pays, deductibles, and/or co-insurances. Co-pays, deductibles, and/or co-insurances are fees that legally cannot be waived or discounted. You will be responsible for your portion of the bill, which is payable at the time of service at each visit. As such, copays, deductibles, and/or co-insurances cannot be paid in advance. In the rare case your insurance carrier is to be billed prior to payment collection, once we receive an EOB from your insurance carrier an itemized bill will be sent to you with any balance owed per your insurance plan.
• Any insurance you may have is an agreement between you and your insurance carrier and you are financially responsible for the payment of any services rendered.
• According to your insurance carrier, verification of your benefits is not a guarantee of payment and final determination will be made for payment of services after a claim is received. The Back Alley Chiropractic is committed to providing the best treatment for our patients. Our professional fees are usual and customary per local state and federal rate tables.

Patient Billing Protocol

While our standard office policy is to require payment at the time of service, there are times when insurance companies must be billed in advance of collecting payment from the patient. In addition, errors can happen during the verification process that may leave a patient with a balance or a credit.

Why do we have a Patient Billing Protocol? We have created this policy to establish a non-discriminatory procedure for our patients.

How do we bill patients? Patient billing is an on-site office process, with patient bills printed on paper, and mailed at 30-day intervals.

What happens to delinquent accounts? Our office utilizes an outside collection agency for patient accounts that are uncollectible.

What happens if a patient has a credit? A credit will remain on a patient’s account until it is either refunded or applied to future dates of service. A patient with a credit may request a refund of said credit at any time, by telephone or mail.

Patient Billing Procedure:

• Patient billing is processed every 30 days at approximately the 15^th day of the month
• Unpaid balances are past due at 30 days of EOB/835 processing
• The patient will receive a FIRST notice indicating the balance due is copay, deductible, or explanation of other reason
• The patient will receive a SECOND notice if balance is left unpaid at the next billing cycle
• The patient will receive a third and FINAL notice to remit payment within 10 days, if balance is left unpaid at the next billing cycle
• If a balance is left unpaid after FINAL notice, the patient is referred to our collection agency for further collection activity

We do not write-off any charges as a standard procedure. Uncollectable accounts should be referred to our collection agency for further collection activity. Samples of acceptable write-offs:

• Allowed amounts by contractual obligation
• Timely filing by contractual obligation
• Medicare QMB eligible members are not responsible for deductible, coinsurance, or copay. This eligibility is verified during the verification process.
• Hardship cases. This eligibility is determined through application process.

Claims Billing Protocol

Claims billing is a process that begins at the Front Desk, with proper collection of information and data entry. It is equally important to collect the information as it is to verify the information received before the patient is rendered payable services. Benefits should NEVER be guessed at.

Why do we have a billing protocol? For our biller to properly submit claims, we must be sure data is entered timely as well as accurately. We must also be sure that patient insurance policies are verified properly.

Who is our biller? At this time we handle all billing in house.

How are claims submitted? We submit claims electronically through a clearinghouse.

How do we verify benefits? Our office utilizes an all in one online access to verify most insurance policies, including Medicare and AHCCCS (Medicaid), as well as many supplemental policies. When necessary, we can utilize online provider portals or provider services by telephone.

Claims Billing Procedure:

• Patient provides identification and insurance information to our office
• Staff contacts insurance company to verify Eligibility and Benefits
• Services are rendered at the time of patient’s appointment
• After services are rendered, the provider identifies CPT codes and ICD-10 codes for diagnosis
• Office Staff enters patient’s data and demographics
  • Demographics must include patient’s full name, address, phone number, date of birth, and policy holder full name, address, phone number, date of birth and employer. IT IS IMPERATIVE this info is entered accurately to avoid claim denials.
  • Other data that is required includes ICD-10 diagnosis codes, onset date for Medicare policies, insurance policy information, and CPT codes for services rendered
• The biller creates insurance claims using the patient’s data. The biller then converts the claim into an electronic file that is submitted to the clearinghouse, which then forwards the claim to the insurance company.
• The insurance company processes the claim and either accepts it or rejects it. The insurance company sends the status decision to the clearinghouse. If the claim is valid, the insurance company will reimburse for services based on network status contracted rates. If the claim is rejected, the insurance company will provide the clearinghouse with a detailed description of why the claim was denied.
• Rejected claims must be promptly corrected and refiled so that timely filing limits are adhered to.
• EOBs and ERAs should be processed timely so that AR records and patient ledgers are continually up to date
• Following the processing of EOBs and ERAs, the patient should be billed for any outstanding balances. Likewise, credits may be refunded by check if requested by patient (see patient billing protocol for more information).